The Evolving Landscape of Healthcare-Associated Infections: Recent Advances in Prevention and a Road Map for Research

This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, “Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA,” which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.

[1]  Jessina C. McGregor,et al.  Economics of infection control surveillance technology: cost-effective or just cost? , 2008, American journal of infection control.

[2]  Craig M. Hales,et al.  The influence of staff and resident immunization rates on influenza-like illness outbreaks in nursing homes. , 2006, Journal of the American Medical Directors Association.

[3]  Sanjay Saint,et al.  Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  R. Platt,et al.  Use of Antibiotic Exposure to Detect Postoperative Infections , 1998, Infection Control & Hospital Epidemiology.

[5]  A. Harris,et al.  Assessing the Burden of Acinetobacter baumannii in Maryland: A Statewide Cross-Sectional Period Prevalence Survey , 2012, Infection Control & Hospital Epidemiology.

[6]  F. Carrat,et al.  Effect of Influenza Vaccination of Nursing Home Staff on Mortality of Residents: A Cluster‐Randomized Trial , 2009, Journal of the American Geriatrics Society.

[7]  C. Gould,et al.  Antibiotic Resistance in Long-Term Acute Care Hospitals The Perfect Storm , 2006, Infection Control & Hospital Epidemiology.

[8]  R. Platt,et al.  Targeted versus universal decolonization to prevent ICU infection. , 2013, The New England journal of medicine.

[9]  M. Klompas Prevention of ventilator-associated pneumonia , 2010, Expert review of anti-infective therapy.

[10]  M. Edmond Getting to Zero: Is It Safe? , 2009, Infection Control & Hospital Epidemiology.

[11]  D. Anderson,et al.  “But My Patients Are Different!”: Risk Adjustment in 2012 and Beyond , 2011, Infection Control & Hospital Epidemiology.

[12]  C. Clancy Getting to Zero: New Resources Aim to Reduce Health Care-Associated Infections , 2010, American journal of medical quality : the official journal of the American College of Medical Quality.

[13]  D. Anderson,et al.  Current Definitions of Central Line–Associated Bloodstream Infection Is the Emperor Wearing Clothes? , 2010, Infection Control & Hospital Epidemiology.

[14]  Stijn Vansteelandt,et al.  Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. , 2011, American journal of respiratory and critical care medicine.

[15]  R. Platt,et al.  Automated methods for surveillance of surgical site infections. , 2001, Emerging infectious diseases.

[16]  A. E. Canda,et al.  ChlorhexidineAlcohol versus PovidoneIodine for Surgical-Site Antisepsis , 2011 .

[17]  Getting to zero: our effort to eliminate infections nationwide. , 2010, Journal of nursing care quality.

[18]  Y. Mehta,et al.  Device-Associated Nosocomial Infections in 55 Intensive Care Units of 8 Developing Countries , 2006, Annals of Internal Medicine.

[19]  F. Hayden,et al.  Preventing Nosocomial Influenza by Improving the Vaccine Acceptance Rate of Clinicians , 2004, Infection Control & Hospital Epidemiology.

[20]  Avid,et al.  A COMPARISON OF SUCRALFATE AND RANITIDINE FOR THE PREVENTION OF UPPER GASTROINTESTINAL BLEEDING IN PATIENTS REQUIRING MECHANICAL VENTILATION , 2001 .

[21]  L. Rice Do we really need new anti-infective drugs? , 2003, Current opinion in pharmacology.

[22]  L. Rice Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. , 2008, The Journal of infectious diseases.

[23]  E. Wong,et al.  Effect of daily chlorhexidine bathing on hospital-acquired infection. , 2013, The New England journal of medicine.

[24]  John M Boyce,et al.  Measuring Healthcare Worker Hand Hygiene Activity: Current Practices and Emerging Technologies , 2011, Infection Control & Hospital Epidemiology.

[25]  G. Guyatt,et al.  A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. , 1998, The New England journal of medicine.

[26]  T. Pruett,et al.  Improved surveillance for surgical site infections after orthopedic implantation procedures: extending applications for automated data , 2010 .

[27]  M. Klompas Interobserver variability in ventilator-associated pneumonia surveillance. , 2010, American journal of infection control.

[28]  J. Timsit,et al.  Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. , 2009, JAMA.

[29]  Sylvia Chong,et al.  Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. , 2009, JAMA.

[30]  R. Platt,et al.  Development of an Algorithm for Surveillance of Ventilator-Associated Pneumonia With Electronic Data and Comparison of Algorithm Results With Clinician Diagnoses , 2008, Infection Control & Hospital Epidemiology.

[31]  V. Quagliarello,et al.  Infectious diseases in the nursing home setting: challenges and opportunities for clinical investigation. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[32]  M. Olsen,et al.  Use of Diagnosis Codes and/or Wound Culture Results for Surveillance of Surgical Site Infection after Mastectomy and Breast Reconstruction , 2010, Infection Control & Hospital Epidemiology.

[33]  M. Bonten,et al.  The role of intestinal colonization with Gram-negative bacteria as a source for intensive care unit-acquired bacteremia* , 2011, Critical care medicine.

[34]  D. Henderson Enhancing Patient Safety by Reducing Healthcare-Associated Infections: The Role of Discovery and Dissemination , 2010, Infection Control & Hospital Epidemiology.

[35]  M. Klompas Advancing the science of ventilator-associated pneumonia surveillance , 2012, Critical Care.

[36]  R. Platt,et al.  Effect of nonpayment for preventable infections in U.S. hospitals. , 2012, The New England journal of medicine.

[37]  M. Arduino,et al.  Editorial commentary: climbing the evidentiary hierarchy for environmental infection control. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[38]  E. D’Agata,et al.  Acquisition of Multidrug-Resistant Gram-Negative Bacteria: Incidence and Risk Factors within a Long-Term Care Population , 2010, Infection Control & Hospital Epidemiology.

[39]  Kerri A. Thom,et al.  Automated hand hygiene count devices may better measure compliance than human observation. , 2012, American journal of infection control.

[40]  F. Ahmed,et al.  Institutional requirements for influenza vaccination of healthcare personnel: results from a nationally representative survey of acute care hospitals--United States, 2011. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[41]  Michael C. Mosier,et al.  Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. , 2010, The New England journal of medicine.

[42]  N. Kouchoukos,et al.  Effect of an implantable gentamicin-collagen sponge on sternal wound infections following cardiac surgery: a randomized trial. , 2010, JAMA.

[43]  R. Platt,et al.  Use of Medicare Claims to Rank Hospitals by Surgical Site Infection Risk following Coronary Artery Bypass Graft Surgery , 2011, Infection Control & Hospital Epidemiology.

[44]  S. Ostroff,et al.  Investigating Systematic Misclassification of Central Line–Associated Bloodstream Infection (CLABSI) to Secondary Bloodstream Infection During Health Care–Associated Infection Reporting , 2013, American journal of medical quality : the official journal of the American College of Medical Quality.

[45]  P. Carling,et al.  Improving Healthcare Environmental Cleaning and Disinfection Current and Evolving Issues , 2013, Infection Control & Hospital Epidemiology.

[46]  Philip Smith,et al.  Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria , 2012, Infection Control & Hospital Epidemiology.

[47]  S. Saint,et al.  Perceived impact of the Medicare policy to adjust payment for health care-associated infections. , 2012, American journal of infection control.

[48]  Teresa C Horan,et al.  Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safely Network , 2011, Infection Control & Hospital Epidemiology.

[49]  T. Pruett Gentamicin–Collagen Sponge for Infection Prophylaxis in Colorectal Surgery , 2011 .

[50]  R. Platt,et al.  Use of Medicare Diagnosis and Procedure Codes to Improve Detection of Surgical Site Infections following Hip Arthroplasty, Knee Arthroplasty, and Vascular Surgery , 2012, Infection Control & Hospital Epidemiology.

[51]  Vital signs: preventing Clostridium difficile infections. , 2012, MMWR. Morbidity and mortality weekly report.

[52]  R. Weinstein,et al.  Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[53]  T. Zaoutis,et al.  Clostridium difficile Infection in children. , 2013, JAMA pediatrics.

[54]  Richard Platt,et al.  Cluster Randomized Trials in Comparative Effectiveness Research: Randomizing Hospitals to Test Methods for Prevention of Healthcare-Associated Infections , 2010, Medical care.

[55]  Getting to Zero: An Emerging Policy Framework for the Elimination of Hospital-Associated Infections , 2009, Infection Control & Hospital Epidemiology.

[56]  Michael Bell,et al.  Vital Signs: Carbapenem-Resistant Enterobacteriaceae , 2013, MMWR. Morbidity and mortality weekly report.

[57]  S. Saint,et al.  Does nonpayment for hospital-acquired catheter-associated urinary tract infections lead to overtesting and increased antimicrobial prescribing? , 2012, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[58]  M. Loeb,et al.  Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. , 2013, JAMA.

[59]  Matthew Samore,et al.  Intervention to reduce transmission of resistant bacteria in intensive care. , 2011, The New England journal of medicine.

[60]  Helen Burstin,et al.  Strategies to Prevent Surgical Site Infections in Acute Care Hospitals , 2008, Infection Control & Hospital Epidemiology.

[61]  E. Perencevich,et al.  National Institute of Allergy and Infectious Disease (NIAID) Funding for Studies of Hospital-Associated Bacterial Pathogens: Are Funds Proportionate to Burden of Disease? , 2012, Antimicrobial Resistance and Infection Control.

[62]  Jennifer L. Hefner,et al.  Getting to Zero , 2016, Medical care research and review : MCRR.

[63]  N. Reich,et al.  Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial , 2013, The Lancet.

[64]  J. A. Kaan,et al.  Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study. , 2011, The Lancet. Infectious diseases.

[65]  Herman Goossens,et al.  Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial , 2014, The Lancet. Infectious diseases.

[66]  Edward H. Kennedy,et al.  Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. , 2012, American journal of infection control.

[67]  S. Saint,et al.  Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. , 2009, Joint Commission journal on quality and patient safety.

[68]  D. Kaufman "Getting to Zero": preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants. , 2012, Early human development.

[69]  T. Katoh [Pertussis or whooping cough]. , 1994, Ryoikibetsu shokogun shirizu.

[70]  B. Souweine,et al.  Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. , 2012, American journal of respiratory and critical care medicine.

[71]  A. Grant,et al.  Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial , 2012, The Lancet.

[72]  W. Schaffner,et al.  Healthcare Workers' Knowledge and Attitudes About Pertussis and Pertussis Vaccination , 2007, Infection Control & Hospital Epidemiology.

[73]  Michael Y. Lin,et al.  The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[74]  A. Caplan,et al.  I N F E C T I O N Control and Hospital Epidemiology Revised Shea Position Paper: Influenza Vaccination of Healthcare Personnel , 2022 .

[75]  P. Pronovost,et al.  An intervention to decrease catheter-related bloodstream infections in the ICU. , 2006, The New England journal of medicine.