Healthcare Acquired Infections (HAIs)

On this page you will find:

 

General Information about HAIs

In American hospitals, healthcare associated infections (HAIs) account for an estimated 1.7 million infections and 99,000 deaths each year. HAIs are infections that patients can get after having medical or surgical treatments.

These infections can happen after surgery or after needles and catheters are inserted through a person's skin.  The skin is the body’s natural protection against bacteria and other organisms. Insertion of needles and devices provide a point of entry for bacteria into the body.  Bacteria can then get into the bloodstream, internal organs and body spaces exposed during a surgery.

Patients in intensive care units (ICUs) have the highest risk of HAIs because of the number of procedures they undergo.  They also have serious health problems. HAIs can make a patient's illness worse and their hospital stay longer. They also can be passed on to other individuals.

For more information on HAIs, go to the U.S. Centers for Disease Control and Prevention (CDC) Web site

 

"Hospital Compare" Web site: www.hospitalcompare.hhs.gov/hospital

In addition to future South Carolina HIDA reports, a useful tool for measuring how well hospitals care for their patients is the Hospital Compare Web site. The site provides information on patient quality of care, including prevention of infections and care of surgical site infections.  Hospital Compare was developed by the Centers for Medicare and Medicaid Services (CMS), an agency that is part of the U.S. Department of Health and Human Services, and the Hospital Quality Alliance (HQA). Hospital Compare is based on data from patient records. Follow the instructions on the Web site to locate specific hospitals in South Carolina

 

Information about HAIs that are reportable in South Carolina

Hospitals began reporting HAIs to DHEC in July 2007. Due to the large number of procedures and hospital locations and to staffing shortages at many hospitals, the types of reportable procedures and clinical locations are being phased in over time.  This phase-in period will give hospitals time to learn the new reporting system and appoint staff to meet the reporting requirements. It will also give DHEC time to evaluate the accuracy and completeness of the hospitals’ reporting procedures.

For now, surgical site infections (SSI) are reported for each type of surgical procedure described in Chart A, below. Certain infection prevention methods have been shown to reduce the risk of infection following surgery.

The SSI rates reported are adjusted to take into account length of the surgical procedure, the type of surgical wound involved, the overall physical condition of patients, and other factors that affect risk of infection. The procedures initially selected for SSI reporting are those that carry a high risk of serious complications as well as those that carry a low risk of infection, but are performed frequently.  In the first reporting period beginning in July 2007, these procedures included abdominal and vaginal hysterectomies and coronary artery bypass surgery. In January 2008, gall bladder surgeries (cholecystectomy and cholecystotomy) and hip and knee replacement procedures were added to the list of conditions that hospitals must report.  
 www.scdhec.gov/hidainfo.

South Carolina hospitals are also reporting central line associated bloodstream infections (CLABSI) in medical and surgical intensive care units (or combination units) as described in Chart A, below.  Central lines are catheters that are inserted into the heart or into a blood vessel leading directly to the heart. Certain infection prevention methods during insertion or when inserting needles into these lines have been shown to reduce the risk of central line infections. 

A hospital might have several types of intensive care units, including coronary, medical, surgical, and pediatric ICUs. To allow for fairer comparison of hospitals, reports of central line-associated bloodstream infections are divided by hospital unit. This takes into account the different types of patients and risks for infection found in each type of ICU.  In January 2008, pediatric intensive care units and smaller hospitals licensed for 150 beds or less began reporting central line-associated bloodstream infections.

Also in January 2008, clinical laboratories in South Carolina began reporting Methicillin resistant Staphylococcus aureus (MRSA) -positive blood cultures as described in Chart B, below. To determine the MRSA bloodstream infection rates for each hospital, MRSA lab reports must first be matched with hospital billing data such as diagnoses, date and time of admission, and length of stay.  These billing reports typically are not finalized for months after the lab results are first reported. DHEC will post MRSA data once six months of matched reports become available or by February 1, 2009, whichever comes first.

A.  New HIDA Reporting requirements - effective date: January 1, 2008

NHSN Patient Safety Protocol

  1. Surgical Site Infections (SSI) for the following procedures, in all hospitals where these procedures are performed:
    • *Coronary Artery Bypass Graft (both chest and donor site incisions)
    • Coronary Artery Bypass Graft (with chest incision only)
    • *Hysterectomy (vaginal and abdominal)
    • Cholecystectomy & cholecystotomy (gallbladder)
    • Hip – prosthesis- (replacement)
    • Knee – prosthesis –(replacement)
  2. Central Line Associated Bloodstream Infections (CLABSI) in hospital units defined by the CDC NHSN system in the following “Locations”:
    • *Medical- Surgical Critical Care Units (all combinations of Medical and Surgical Critical Care)
    • Pediatric Critical Care Units, (all combinations of Medical - Surgical as defined by NHSN)
    • All inpatient locations in Acute Care Hospitals licensed for 150 beds or less, using location type as defined by NHSN.  (Does not include long term acute care locations at this time.)

* reporting requirements were effective July 1, 2007

 

B.  NewHIDA Reporting requirements - effective date: January 1, 2008

DHEC List of Reportable Conditions:

All clinical laboratories must begin reporting MRSA bloodstream infections as shown below:

  1. Methicillin resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI)
    • MRSA bloodstream infections (BSI) have been added to the DHEC 2008 List of Reportable Conditions 
    • Microbiology laboratories are required to report all MRSA positive blood culture results from inpatients and outpatients and the antibiotic resistance pattern along with patient specific information needed to identify probable hospital associated infections.
    • A hospital associated MRSA infection is defined as an MRSA bloodstream infection in a patient with the first positive culture collected more than 48 hours after admission. 
    • Infection incidence rates will be based on the number of inpatient hospital associated MRSA bloodstream infections reported in six months over the number of total occupied bed days in the same six month period x 1,000.  Annual rates will also be reported.
    • DHEC will link the MRSA positive lab reports (date of specimen collection) with the Office of Research and Statistic Hospital Discharge Data  for each patient (date of admission) to identify cases meeting the definition and then calculate the denominator (total number of occupied bed days in each hospital / six months period) x 1,000.