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