The Hospital Infections Program (HIP) is dedicated to assisting the Public Health Service, state and local health departments, hospitals, and professional organizations worldwide in the prevention and control of nosocomial infections.
The Hospital Infections Program (HIP) of the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), is the focus for information, surveillance, investigation, prevention, and control of nosocomial infections for the Public Health Service, state and local health departments, hospitals, and professional organizations in the United States and around the world.
Nosocomial infections affect approximately 2million patients annually in acute care facilities in the United States ata direct annual patient care cost of approximately $3.5 billion.
Studies indicate that one-third of nosocomial infections can be prevented by well-organized infection control programs, yet only 6%-9% are actually prevented. Addressing the discrepancy between what can be prevented and what is being prevented is a major focus for HIP, the Joint Commission on Accreditation of Health Care Organizations, professional organizations, and hospital infection control personnel in the 1990s.
The Study on the Efficacy of Nosocomial Infection Control (SENIC), carried out by HIP over ten years, showed that to be effective, nosocomial infection programs must include the following: 1)organized surveillance and control activities, 2)a ratio of one infection control practitioner for every 250 acute care beds, 3)a trained hospital epidemiologist, and 4)a system for reporting surgical wound infection rates back to practicing surgeons.
NNIS began in 1970 when selected U.S. hospitals routinely reported their nosocomial infection surveillance data into a national database. Hospitals participating in NNIS provide general medical and surgical inpatient services to adults or children requiring acute care; more than 180 hospitals are currently participating. NNIS is the only source of national surveillance data on nosocomial infections in the United States.
The objectives of NNIS are to
Information gathered from 20 years of NNIS surveillance has been used to advise hospitals on effective methods for conducting surveillance of nosocomial infections. Knowledge of nosocomial infection rates serves as a stimulus for hospitals to evaluate their infection control programs and can provide a benchmark for national comparisons. These methods can also be used for assessing nonnosocomial infection outcomes of hospital care.
Each year, HIP receives more than 5,000 inquiries on nosocomial infections; approximately 2% of these inquiries involve management of acute outbreaks. Most outbreaks requiring assistance are handled locally, with HIP providing technical advice. In certain cases, however, such as those involving intrinsic product contamination or new or particularly severe disease, HIP provides on-site epidemiologic assistance.
In the past decade, HIP staff have investigated approximately 120 hospital outbreaks. Some of these outbreaks have involved previously unreported problems, such as an unusual and fatal illness among neonates that was associated with a newly marketed intravenous vitamin E preparation; intrinsic contamination of commercially prepared povidone-iodine; HIV transmission in dialysis centers in Africa and South America; nosocomial transmission of Mycobacterium tuberculosis; Nocardia farcinica infections in cardiac surgery patients; vancomycin-resistant enterococcal infections; complications of intravascular catheters in hospital or home infusion patients; and transmission of Yersinia enterocolitica from mildly ill or asymptomatic blood donors to transfusion recipients.
Recently, epidemiologic studies have focused on intensive care unit (ICU) patients; the annual cost of ICU care in the United States is $10-$20 billionmore than 20% of all hospital costs.
Epidemiologic studies also identify risk factors for endemic infections so that preventive strategies can be formulated and implemented. These strategies include measures to reduce the risk for infection associated with invasive techniques for intravascular pressure monitoring and hyperalimentation.
HIP has two laboratory branches that provide support for epidemiologic investigations and longitudinal studies. The laboratories 1) determine the etiology of an infectious illness by isolating and identifying pathogens in specimens from patients, medical devices, or environmental sources; 2) isolate microorganisms in pure culture and identify them by using automated or semiautomated systems; and 3) type strains of microorganisms, by a variety of techniques, to determine whether a cluster of isolates of the same species are from the same clone. New molecular techniques used to characterize and/or detect nosocomial pathogens include plasmid analysis, restriction enzyme analysis, protein analysis, multilocus enzyme analysis, ribotyping, DNA probes, DNA-DNA hybridization, polymerase chain reaction, DNA sequencing, and electrophoretic karyotyping.
Antimicrobial resistance is an important area of active laboratory investigation at CDC. HIP's activities involving antimicrobial resistance include defining the molecular mechanisms of resistance; evaluating and standardizing methods for antimicrobial susceptibility testing, including testing of devices, kits, and novel agents; collaborating with organizations, such as the National Committee on Clinical Laboratory Standards, to establish uniform susceptibility testing methods; and actively participating in surveillance studies of antimicrobial resistance trends, both nationally and internationally.
In addition, the HIP laboratories evaluate new biochemical identification methods and publish the results to advise clinical microbiologists on the methods' strengths and weaknesses; develop methods for strain typing of nosocomial pathogens to improve the capability of clinical laboratories to track nosocomial infections; provide reference identification services for many gram-negative bacilli, anaerobes, and staphylococci; assess the role of hemodialysis equipment, other medical devices, and environmental sources in the transmission of nosocomial pathogens; develop and evaluate strategies for disinfection and sterilization in the hospital, hemodialysis, and other health care settings; and advise, consult, and collaborate with other CDC, federal, university, and industry groups on these issues.
Approximately 6.9 million health care workers in the United States are at risk for HIV infection from blood contact in their work environment. These workers include surgeons, obstetricians, other operating/delivery room personnel, nurses, phlebotomists, nonsurgeon physicians, dental workers, laboratory and autopsy personnel, and first responders who provide emergency medical care. HIV transmission has also been reported from patient to patient and, in one case, from a health care worker to patients.
In 1983, to evaluate the risk for HIV infection from exposure to blood of HIV-infected patients, HIP began a national prospective surveillance system for health care workers who were exposed to blood of these patients through percutaneous, mucous membrane, or nonintact skin contact.
HIP is also studying the nature and frequency of blood contacts among health care workers to determine the proportions of blood contacts that place workers and possibly patients at risk for HIV infection and the efficacy of preventive measures in reducing exposure to blood and certain other body fluids.
HIP uses data from these and other studies to develop guidelines for preventing HIV transmission in health care settings. The first guidelines were published in 1982, well before the cause of AIDS was known. The latest set of guidelines, referred to as Universal Precautions, identifies blood and certain body fluids from all patients as potentially infectious and recommends the use of appropriate barrier precautions to prevent blood contact.
The Child Care Health and Safety Program coordinates CDC's research and intervention activities for promoting health and reducing the incidence of infectious disease, injury, and exposure to environmental toxins among children and staff in child care settings, and for preventing the spread of disease from these children and workers to other family members.
The program provides ongoing consultation and technical assistance to state and local health agencies, health care and child care providers, and others; develops and distributes educational and training materials; evaluates the effectiveness of prevention and intervention measures; promotes health communications in the out-of-home child care setting; and seeks new ways to improve the health of children by using child care settings as focal points for delivery of child health services.
The program works closely with national public health, health care, and child care organizations to promote a healthy and safe out-of-home child care environment for all children, child care providers, and their families.
A number of infectious diseases and noninfectious complications, including hepatitis B, hepatitis C, HIV infection, septicemia, endotoxemia, chemical intoxication, and first-use dialyzer syndrome, have been associated specifically with hemodialysis treatments. HIP, in collaboration with the Health Care Financing Administration, conducts a nationwide surveillance program to obtain information on specific dialysis-associated diseases and infection control practices in dialysis settings.
Results from recent surveillance indicate that the incidence of dialysis-associated hepatitis B is 0.2%, which represents a 95% decrease from 1977 when CDC first published guidelines on the control of hepatitis B in dialysis settings.
Recognizing a need for training hospital epidemiologists, HIP, the Society for Healthcare Epidemiology of America (SHEA), and the American Hospital Association (AHA) have developed a training course for hospital epidemiologists. The SHEA/CDC/AHA Course for Hospital Epidemiologists has been offered annually since 1988 and has trained over 150 physicians.
HIP sponsors other courses and conferences on topics of interest to the hospital community. In addition, HIP epidemiologists and laboratory researchers publish articles on epidemiologic research and investigation, participate in national and international scientific meetings, and serve as consultants to organizations developing infection control guidelines.
Recent HIP guidelines for health care workers include the Guideline for Prevention of Nosocomial Pneumonia, Report on Preventing the Spread of Vancomycin Resistance, Guideline for Isolation Precautions in Hospitals, and Guideline for Preventing the Transmission of Tuberculosis in Healthcare Facilities.
HIP and the National Center for Infectious Diseases are committed to the principles of Equal Employment Opportunity and Affirmative Action.
Further information on the Hospital Infections Program is available from:
Office of the Director, HIP, Mailstop A07
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