title: Preventing device-associated infections in US hospitals: national surveys from 2005 to 2013.
abstract: BACKGROUND
  Numerous initiatives have focused on reducing device-associated infections, contributing to an overall decrease in infections nationwide. To better understand factors associated with this decline, we assessed the use of key practices to prevent device-associated infections by US acute care hospitals from 2005 to 2013.
  
  
  METHODS
  We mailed surveys to infection preventionists at a national random sample of ∼600 US acute care hospitals in 2005, 2009 and 2013. Our survey asked about the use of practices to prevent the 3 most common device-associated infections: central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI). Using sample weights, we estimated the per cent of hospitals reporting regular use (a score of 4 or 5 on a scale from 1 (never use) to 5 (always use)) of prevention practices from 2005 to 2013.
  
  
  RESULTS
  The response rate was about 70% in all 3 periods. Use of most recommended prevention practices increased significantly over time. Among those showing the greatest increase were use of an antimicrobial dressing for preventing CLABSI (25-78%, p<0.001), use of an antimicrobial mouth rinse for preventing VAP (41-79%, p<0.001) and use of catheter removal prompts for preventing CAUTI (9-53%, p<0.001). Likewise, a significant increase in facility-wide surveillance was found for all three infections. Practices for which little change was observed included use of antimicrobial catheters to prevent either CLABSI or CAUTI.
  
  
  CONCLUSIONS
  US hospitals have responded to the call to reduce infection by increasing use of key recommended practices. Vigilance is needed to ensure sustained improvement and additional strategies may still be required, given an apparent continuing lag in CAUTI prevention efforts.
authors: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors: Sarah L
authors: SL
authors: Krein
authors: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
authors: Karen E
authors: KE
authors: Fowler
authors: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
authors: David
authors: D
authors: Ratz
authors: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors: Jennifer
authors: J
authors: Meddings
authors: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors: Sanjay
authors: S
authors: Saint
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D020380:Needs Assessment; D061214:Patient Safety; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D014481:United States; D014546:Urinary Catheterization / Q000009:adverse effects
keywords: Hospital medicine; Infection control; Nosocomial infections; Patient safety