title: Longitudinal trends in all healthcare-associated infections through comprehensive hospital-wide surveillance and infection control measures over the past 12 years: substantial burden of healthcare-associated infections outside of intensive care units and "other" types of infection.
abstract: OBJECTIVE
  Targeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001-2012).
  
  
  METHODS
  This retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time.
  
  
  RESULTS
  A total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (-3.4 infections per 1,000 patient days), in ICUs (-8.4 infections per 1,000 patient days), and in non-ICU settings (-1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million.
  
  
  CONCLUSIONS
  We demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non-device-associated HAIs, and for CDI.
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kanamori
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: DiBiase
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Sickbert-Bennett
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Brooks
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: Lisa
authors.initials: L
authors.lastname: Teal
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Walters
authors.affiliation: 1Hospital Epidemiology,University of North Carolina Health Care,Chapel Hill,North Carolina.
authors.forename: William A
authors.initials: WA
authors.lastname: Rutala
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D017053:Infection Control; D008137:Longitudinal Studies; D009657:North Carolina; D062486:Public Health Surveillance; D012189:Retrospective Studies