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N Engl J Med. 2018 Nov 1;379(18):1732-1744. doi: 10.1056/NEJMoa1801550.

Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals.

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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).



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.).


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