Nationally , among acute-care hospitals , CLABSI , CAUTI , VAE , MRSA , and CDI continue to decline in 2023 compared to 2022 . Additionally , CAUTI , MRSA , and CDI 2023 SIRs are below pre-pandemic ( 2019 ) standardized infection ratios ( SIRs ), which measure progress in reducing HAIs compared to the 2015 baseline time period . The SIR is the ratio of the observed number of infections ( events ) to the number of predicted infections ( events ) for a summarized time period . In addition to the SIRs , the report includes the standardized utilization ratios ( SURs ), which measure device use by comparing the number of observed device days to the number of predicted device days . The SIR and SUR metrics are calculated using the 2015 national baseline and risk adjustment methodology .
Overall , there was an approximate 13 percent decrease in CLABSI between 2022 and 2023 . Decreases were observed in all location settings , including the intensive care unit ( ICU ), 20 percent ; neonatal ICU ( NICU ), 13 percent ; and wards , 8 percent .
Overall , there was an 11 percent decrease in CAUTI between 2022 and 2023 . Decreases were observed across ICU locations ( 16 percent ) and ward locations ( 8 percent ).
Overall , there was a 5 percent decrease in VAE between 2022 and 2023 . A 5 percent decrease was observed in ICU locations ; however , a 9 percent increase was observed in ward locations .
This good news is tempered by a 3 percent increase in SSI combined SCIP procedures between 2022 and 2023 . The 10 select procedures are Surgical Care Improvement Project ( SCIP ) procedures . It should be noted that the initial set of acute-care hospital targets and metrics included a measure on SCIP processes ; that measure is no longer part of the HAI Action Plan because these processes are now widely accepted as standards of practice .
There was an 8 percent increase in abdominal hysterectomy SSIs . No significant changes in colon surgery SSIs were noted . Facilities participating in NHSN reporting observed a 16 percent decrease in hospitalonset MRSA bacteremia between 2022 and 2023 , while observing a 13 percent decrease in hospital onset C . difficile infections between 2022 and 2023
On the state level compared to itself from 2022 to 2023 , 30 states performed better on at least two infection types , while 21 states performed better on at least three infection types , nine states performed better on at least four infection types , and two states performed worse on two or more infection types .
Regarding state performance compared to the 2015 baseline SIR of 1 , 49 states
Healthcare facilities have continued to stabilize after coming out of the COVID-19 pandemic . The kind and the degree of drains on healthcare systems that happened in 2021 and 2022 are being corrected , and that ’ s a good thing . I think we ’ re back to the usual challenges we had before the COVID-19 pandemic , including maintaining sustainable hardwired practices toward infection prevention in all healthcare settings .”
— Thomas Talbot , MD , MPH , FIDSA , FSHEA
performed better on at least three infection types , 36 states performed better on at least four infection types , 20 states performed better on at least five infection types , and four states performed worse on at least two or more infection types .
For state performance compared to the 2023 national SIR , 21 states performed better on at least two infection types ; of these , 10 states performed better on at least three infection types , and of these , three states performed better on at least four infection types . Conversely , 24 states performed worse on two or more infection types , and of these , 15 states performed worse on at least three infection types and of these , three states performed worse on at least four infection types .
Making Progress , but More Work Lies Ahead
While progress has been made , experts continue to say that more needs to be done to prevent HAIs in a variety of settings . As the CDC observes , “ Full engagement between local , state and federal public health agencies and their partners in the healthcare sector through initiatives such as prevention collaboratives is vital to sustaining and extending HAI surveillance and prevention progress . CDC will continue its prevention , tracking , lab , and applied research activities to push the country further toward the goal of eliminating HAIs .”
Thomas Talbot , MD , MPH , FIDSA , FSHEA , a professor of medicine in the Division of Infectious Diseases within the Department of Medicine , as well as chief hospital epidemiologist for Vanderbilt University Medical Center , characterized HAI-prevention efforts during the last several
years as realistic , given the lingering effects of the pandemic .
“ Healthcare facilities have continued to stabilize after coming out of the COVID-19 pandemic ,” he confirms , adding that , “ The kind and the degree of drains on healthcare systems that happened in 2021 and 2022 are being corrected , and that ’ s a good thing . I think we ’ re back to the usual challenges we had before the COVID-19 pandemic , including maintaining sustainable hardwired practices toward infection prevention in all healthcare settings . We know from before the pandemic that acute-care hospitals are usually ahead of other types of facilities in some HAI-prevention practices and the resources needed to implement them . And so , that ’ s where I envision healthcare facilities will be pivoting going into 2025 .”
Talbot continues , “ I think the second aspect of 2025 involves what the change in presidential administration will mean for our sector . We know that there will be new perspectives coming into the realm of public health that could impact infection prevention , so , how can we identify and address those common concerns around things like ensuring we have safe healthcare without infectious harms , that antimicrobial resistance does not continue to grow , and other key issues . We will all need to continue to navigate those challenges if they come forward in the next few years .”
Deborah Yokoe , MD , MPH , FSHEA , a professor of clinical medicine in the Division of Infectious Diseases , Department of Medicine at University of California San Francisco ( UCSF ) and medical director for hospital epidemiology and infection prevention for adult services , agrees with Talbot that facilities are emerging from the pandemic era with some lingering challenges and new opportunities to move the needle on HAI incidence .
“ There have been some recent overall improvements in HAI outcomes , at least among the HAIs that are commonly tracked , but challenges remain around our ability to sustain those improvements over time . As Dr . Talbot mentioned , the improvements in HAI outcomes that we ’ re now seeing likely reflect the fact that we are coming out of the COVID-19 pandemic and are able to focus more of our infection prevention and control resources back on core infection prevention strategies . Despite this , there are ongoing opportunities for improvement , for example , for CLABSI , we ’ re not quite back down to the point where we were prior to the COVID-19 pandemic . The negative impacts on HAI outcomes that we saw at the height of the COVID-19 pandemic and subsequent improvements that we ’ ve achieved through reprioritizing HAI prevention efforts highlight the importance of healthcare facilities focusing enough
12 • www . healthcarehygienemagazine . com • jan-feb 2025