Burden estimates to
support prioritization of
public health problems
Burden estimates to
support prioritization of
public health problems
Challenges to National
Estimates of Healthcare-
Associated Infections in
U.S. Hospitals
No single source of representative
data available to estimate burden
in the United States
In 2002, available data were
–
National Nosocomial Infections
Surveillance System
–
American Hospital Association
Survey
–
National Hospital Discharge Survey
Calculation of estimates of healthcare-associated
infections in U.S. hospitals among adults and
children outside of intensive care units, 2002
HRN = high risk newborns
WBN -= well-baby nurseries
ICU = intensive care unit
SSI = surgical site infections
BSI – bloodstream infections
UTI = urinary infections
PNEU = pneumonia
SSI
20%
BSI
11%
UTI
36%
PNEU
11%
Other
22%
133,368
424,060
263,810
129,519
274,098
-967
-21
-28,725
244,385
TOTAL
HRN
WBN
Non-newborn ICU
= SSI
Klevens, et al. Pub Health Rep 2007;122:160-6
Rates of Healthcare-Associated
Infections in Newborns, Adults, and
Children by Site of Infection, National
Nosocomial Infections Surveillance
(NNIS) System
Well-baby nursery
a
High-risk nursery
b
Intensive
care unit
b
(adults and
children)
Patient-days
c
7,436,520
4,835,702
30,236,811
Major site of infection
Rate of infection per
1,000 patient-days
Urinary tract
0.19
0.5
3.38
Bloodstream
0.76
3.06
2.71
Pneumonia
0.24
0.91
3.33
Surgical site 0.003
0.2
0.95
Other
1.37
2.21
2.67
Total
2.56
6.88
13.04
a
From NNIS hospital-wide surveillance, 1990-1995
b
From NNIS surveillance 2002, high-risk nursery and ICU component
c
From the National Hospital Discharge Survey (NHDS) for the U.S. population in
non-federal hospitals
Estimated Number of Healthcare-
Associated Infections in U.S. Hospitals
by Subpopulation and Major Site of
Infection, United States, 2002
Outside of
Intensive careintensive care
Major siteWell-babyHigh-riskunit (adultsunits (adults Unadjusted
Adjusted
of infectionnurserynurseryand children)and children)
a
total
total
b
Percentage
Urinary tract 1,413 2,418 102,200
424,060 530,091 561,667 32
Bloodstream 5,65214,797
81,942
133,368 235,759 248,678 14
Pneumonia 1,785 4,400
100,689
129,519 236,393 250,205 15
Surgical site 21 967
28,725
244,385 274,098 290,485 22
Other
10,188 10,687
80,732
263,810 365,417 386,090 17
Total
19,059 33,269
394,288
1,195,142 1,641,7581,737,125 100
a
See proportions applied from description in Figure.
b
Adjusted for inclusion of federal hospitals by multiplying non-newborn values by
1.06
Klevens, et al. Pub Health Rep 2007;122:160-6
Burden of Healthcare-
Associated Infections in
the United States, 2002
1.7 million infections in hospitals
–
Most (1.3 million) were outside of ICUs
–
9.3 infections per 1,000 patient-days
–
4.5 per 100 admissions
99,000 deaths associated with
infections
–
36,000 – pneumonia
–
31,000 – bloodstream infections
Klevens, et al. Pub Health Rep 2007;122:160-6