Indiana State Health Improvement Plan (I-SHIP) - State of Indiana

Reduce Healthcare Associated Infections
Healthcare associated infections are infections that patients acquire within a
healthcare setting during the course of receiving treatment for other
conditions. Healthcare associated infections include:
� Central line associated bloodstream infections (CLABSI)
� Catheter associated urinary tract infections (CAUTI)
� Clostridium difficile infection (CDI or C diff)
� Methicillin resistant Staphylococcus aureus (MRSA)
� Surgical site infections (SSI)
� Ventilator associated pneumonia (VAP)
Evidence suggests that healthcare associated infections are an increasing
healthcare problem in part resulting from multi-drug resistant organisms.
Studies have estimated that 5% of all admissions to an acute care setting
result in a healthcare associated infection. Infections result in 99,000 deaths
per year nationally. Hospital costs per infection range from $1,000 for a
catheter associated urinary tract infection to $36,000 for a central line
associated bloodstream infection resulting in excess costs of over $28 billion
per year.
In a 2009 study of long term care facilities, one-third of long term care
residents were affected by respiratory disease outbreaks. A 2008 study of
Veterans healthcare facilities found a healthcare associated infection
prevalence of 5.2% with 25% of residents having an indwelling medical
device and therefore at increased risk for infections.
An example of increasing prevalence of infections is Clostridium difficile.
In May of 2008, the Association of Professionals in Infection Control and
Epidemiology (APIC) conducted a national prevalence study of Clostridium
difficile. Facilities were to take one day during the month and report on
their Clostridium difficile incidence for that day. Data showed that 13 out of
every 1,000 inpatients in the survey were either infected (94.4%) or
colonized (5.6%). This was 6.5 to 20 times previous estimates. Data also
indicated that 69.2% were over 60 years of age and 67.6% had co-morbid
conditions (renal failure, diabetes, heart failure); 10.9% had an initial
episode of severe to complicated disease. 35.1% had long term care facility
residence within 30 days of onset and 47.4% had hospitalization within 90
days of onset. 79.4% had antimicrobial exposure before onset.
Indiana data supports the increase in reported cases of Clostridium difficile
infections from 2002 to 2007. The following charts show Clostridium
difficile data for Indiana: