_______________________________________________________________ Healthcare-Associated Infections
CHARACTERISTICS OF THE MOST COMMON HEALTHCARE-ASSOCIATED INFECTIONS
Infection
Proportion of All HAIs
Incidence
Costs
Excess Stay
Attributable Mortality
Mean Hospital Cost per Infection (U.S. Dollars)
Catheter-associated urinary tract infection
32%
20% to 40% of patients with an indwelling catheter 1% to 3% of surgical patients 1% of patients with a central line 10% to 65% of intubated patients
10 days
1%
$1,006
Surgical site infection 22%
7 to 10 days
3% to 5%
$25,546
Central line-associated bloodstream infection Ventilator-associated pneumonia Healthcare-associated pneumonia (other than ventilator associated)
14%
10 to 20 days
35%
$36,441
15%
4 days
10% to 50% $9,966
<1%
NA
NA
NA
NA
Clostridioides difficile - associated diarrhea
Not available 30% of hospitalized adults with diarrhea
3 to 6 days
6% to 7% $9,000–$11,000
NA = Not available. Source: [1; 32; 40; 78; 81; 132; 133; 134; 135; 136; 137]
Table 6
The risk factors for each of these HAIs have been delineated in many studies ( Table 7 ) [22; 39; 78; 138; 139; 140; 141; 142; 143; 144]. Yet, predicting which patients are at risk can be difficult. In one study, physicians in a surgical ICU were asked to assess at admission the individual risk of major HAI during the patient’s stay in the unit. The investigators found that the physicians could not accurately predict risk, with positive predictive values that ranged from 8.4% to 14.5% and negative predictive values that ranged from 92.1% to 100% [145]. HAIs are predominantly caused by bacteria. Between Janu- ary 2018 and December 2021, 452,940 pathogens (401,323 HAIs) were reported to the NHSN [146]. Surgical site infec- tions contributed to the highest proportion of HAIs (47.6%), followed by central-line associated bloodstream infections (25.1%), catheter-associated urinary tract infections (23.8%), and ventilator-associated pneumonia (3.5%). E. coli was the most common pathogen across all HAIs, accounting for just over 16% of reported pathogens. Approximately 74% of the reported pathogens belonged to one of nine main pathogen groups [146]: • E. coli (16.2%) • Enterococcus spp. (12.3%) • S. aureus (11.3%) • Selected Klebsiella spp. (8.5%) • P. aeruginosa (7.9%) • Coagulase-negative staphylococci (7.1%)
• Enterobacter spp. (4.1%) • Proteus spp. (3.1%) • Candida albicans (3.6%)
The micro-organisms causing HAIs vary according to several factors, including the type of infection; in the overviews of the HAIs that follow, the most common micro-organisms specific to each infection are noted. Infectious agents also vary among healthcare facilities and even units within a single institution. Knowledge of trends in the pathogens responsible for HAIs is important in determining appropriate empiric therapy. This information changes frequently, and healthcare professionals should remain up to date with the pathogens identified in their own healthcare facilities and even on specific units within the facility. The IDSA/SHEA recommends computer-based surveillance (level II, B) as part of an overall antimicrobial stewardship program [72].
CATHETER-ASSOCIATED URINARY TRACT INFECTIONS
The IDSA defines a catheter-associated urinary tract infec- tion as an infection occurring in a patient with an indwelling urinary catheter either currently in place or in place within the previous 48 hours [32]. Approximately 15% to 25% of inpatients will have a urinary catheter inserted at some time during the hospital stay, and a urinary tract infection will develop in 20% to 40% of them [23; 32]. The risk of infection varies from 3% to 8% per day when an indwelling catheter is in place [32].
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