From the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, (S.S.M., E.O., C.G., J.B., D.L., E.S., F.B., R.P., J.R.E.), the Department of Medicine, Emory University (S.M.R.), CACI (C.G., J.B., D.L., E.S.), and Eagle Medical Services (F.B.) - all in Atlanta; Colorado Department of Public Health and Environment, Denver (S.J.J., W.B., T.O.); New Mexico Department of Health, Santa Fe (D.L.T., M. Sievers, S.S.), and Presbyterian Healthcare Services (D.L.T.) and University of New Mexico (E.B.H.), Albuquerque; New York Emerging Infections Program and University of Rochester Medical Center, Rochester (G.D., C.C.); California Emerging Infections Program, Oakland (J.N.); Maryland Department of Health, Baltimore (L.E.W., N.B., K.R.); Tennessee Department of Health, Nashville (M.A.K.); Minnesota Department of Health, St. Paul (R.L., L.W., J.R.); Connecticut Emerging Infections Program, New Haven and Hartford (S.G., M.M.); Georgia Emerging Infections Program, Decatur (S.M.R.); and Oregon Health Authority, Portland (Z.B., V.O., M. Samper).
N Engl J Med. 2018 Nov 1;379(18):1732-1744. doi: 10.1056/NEJMoa1801550.
A point-prevalence survey that was conducted in the United States in 2011 showed that 4% of hospitalized patients had a health care-associated infection. We repeated the survey in 2015 to assess changes in the prevalence of health care-associated infections during a period of national attention to the prevention of such infections.
At Emerging Infections Program sites in 10 states, we recruited up to 25 hospitals in each site area, prioritizing hospitals that had participated in the 2011 survey. Each hospital selected 1 day on which a random sample of patients was identified for assessment. Trained staff reviewed medical records using the 2011 definitions of health care-associated infections. We compared the percentages of patients with health care-associated infections and performed multivariable log-binomial regression modeling to evaluate the association of survey year with the risk of health care-associated infections.
In 2015, a total of 12,299 patients in 199 hospitals were surveyed, as compared with 11,282 patients in 183 hospitals in 2011. Fewer patients had health care-associated infections in 2015 (394 patients [3.2%; 95% confidence interval {CI}, 2.9 to 3.5]) than in 2011 (452 [4.0%; 95% CI, 3.7 to 4.4]) (P<0.001), largely owing to reductions in the prevalence of surgical-site and urinary tract infections. Pneumonia, gastrointestinal infections (most of which were due to Clostridium difficile [now Clostridioides difficile]), and surgical-site infections were the most common health care-associated infections. Patients' risk of having a health care-associated infection was 16% lower in 2015 than in 2011 (risk ratio, 0.84; 95% CI, 0.74 to 0.95; P=0.005), after adjustment for age, presence of devices, days from admission to survey, and status of being in a large hospital.
The prevalence of health care-associated infections was lower in 2015 than in 2011. To continue to make progress in the prevention of such infections, prevention strategies against C. difficile infection and pneumonia should be augmented. (Funded by the Centers for Disease Control and Prevention.).
2011 年在美国进行的一项时点患病率调查显示，4%的住院患者存在医疗保健相关感染。我们在 2015 年重复了这项调查，以评估在全国关注此类感染预防期间，医疗保健相关感染的患病率变化。
在 10 个州的新发感染项目（EIP）地点，我们在每个地点区域招募了多达 25 家医院，优先选择参加过 2011 年调查的医院。每家医院选择 1 天，对随机抽取的患者样本进行评估。训练有素的工作人员使用 2011 年医疗保健相关感染的定义来审查病历。我们比较了患有医疗保健相关感染的患者的百分比，并进行多变量对数二项式回归建模，以评估调查年份与医疗保健相关感染风险之间的关联。
2015 年，在 199 家医院中共有 12299 名患者接受了调查，而在 2011 年，在 183 家医院中，有 11282 名患者接受了调查。2015 年患有医疗保健相关感染的患者较少（394 例[3.2%；95%置信区间{CI}，2.9 至 3.5]），而 2011 年为 452 例（4.0%；95%CI，3.7 至 4.4%）（P<0.001），这主要归因于手术部位和尿路感染患病率的降低。肺炎、胃肠道感染（其中大多数是由艰难梭菌[现更名为艰难梭菌]引起的）和手术部位感染是最常见的医疗保健相关感染。与 2011 年相比，2015 年患者发生医疗保健相关感染的风险低 16%（风险比，0.84；95%CI，0.74 至 0.95；P=0.005），经年龄、设备存在、从入院到调查的天数和大型医院状况调整后。
2015 年的医疗保健相关感染患病率低于 2011 年。为了继续在预防此类感染方面取得进展，应加强针对艰难梭菌感染和肺炎的预防策略。（由疾病控制和预防中心资助）。
