The U.S. Department of Health and Human Services (HHS) released targets for the national acute care hospital metrics for the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan) in October 2016. The targets use data from calendar year 2015 as a baseline — and were in effect for a 5-year period from 2015 to 2020. HHS is currently working to update this plan with new indicator targets and data, new research and intervention efforts, and a review of the impact of the COVID-19 public health emergency on HAIs.
The measures track population-based harm from HAIs at the national level. These measures address the following goals from the HAI Action Plan:
- Reduce central line-associated bloodstream infections (CLABSI) in intensive care units and ward-located patients
- Reduce catheter-associated urinary tracts infections (CAUTI) in intensive care units and ward-located patients
- Reduce the incidence of invasive healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections
- Reduce hospital-onset MRSA bloodstream infections
- Reduce hospital-onset Clostridioides difficile infections (CDI)
- Reduce the rate of Clostridioides difficile hospitalizations
- Reduce surgical site infections (SSI)
Progress: National Acute Care Hospital HAIs
|Measure (and data source)||Progress made 2016 (from 2015 baseline)||Progress made 2019 (from 2015 baseline)||2020 Target (from 2015 baseline)|
|CLABSI (NHSN)1||11% reduction||31% reduction||50% reduction|
|CAUTI (NHSN)1||7% reduction||26% reduction||25% reduction|
|Invasive MRSA (NHSN/EIP)1, 2||8% reduction||5% increase4||50% reduction|
|Hospital-onset MRSA (NHSN)1||6% reduction||18% reduction||50% reduction|
|Hospital-onset CDI (NHSN)1||8% reduction||42% reduction||30% reduction|
|SSI (NHSN)1||6% reduction||7% reduction||30% reduction|
|Clostridioides difficile-related hospitalizations (HCUP)3||4% reduction||29% reduction||30% reduction|
1 NHSN: The National Healthcare Safety Network, of the Centers for Disease Control and Prevention (CDC), is the nation's most widely used healthcare-associated infection tracking system. Since 2009, infection data has been reported to the NHSN to track the national progress of the reduction of HAIs.
2 EIP: CDC's Healthcare-Associated Infections - Community Interface (HAIC), a component of the Emerging Infections Program, is an active population-based surveillance system for HAIs caused by pathogens such as MRSA. These EIP sites also use the NHSN to perform time-limited evaluations of HAIC data among NHSN facilities participating in the EIP NHSN network.
3 HCUP: The Agency for Healthcare Research and Quality's (AHRQ)'s Healthcare Cost and Utilization Project is the nation's most comprehensive source of hospital data. HCUP data is used to track hospitalizations due related to Clostridium difficile. HCUP can be used to distinguish between hospital-acquired and community-acquired hospitalizations related to C. diff.
4 CDC data for 2019 is delayed for this measure due to COVID-19 within the EIP data source. This indicates progress made between the 2015 baseline and 2018.
Progress in reducing HAIs, as assessed by NHSN data, is tracked using a standardized infection ratio (SIR). The SIR compares the number of HAIs observed to the predicted number of infections. The predicted number is a risk-adjusted estimate that is determined using national baseline data. Healthcare facilities, state and local health departments, and federal agencies like the Centers for Medicare and Medicaid Services (CMS) can use NHSN data to identify problem areas and target HAI prevention efforts within specific facilities, regions, and states.
Progress in reducing Clostridioides difficile hospitalizations is tracked using AHRQ's HCUP State Inpatient Databases, beginning in 2010 (the date at which complete data was available for whether the data was present on admission). A description of the HCUP data, methodology and progress toward eliminating CDI in nonfederal short-term general and other specialty hospitals can be found at AHRQ's report on Adult, Nonmaternal Inpatient Stays Related to Clostridioides difficile: National Trends, 2011-2016 and 2019.
CDC publishes data reports to help track progress and target areas that need further assistance. The CDC data comes from two complementary HAI surveillance systems, the National Healthcare Safety Network (NHSN) and the Emerging Infections Program Healthcare-Associated Infections – Community Interface (EIP HAIC). NHSN data are used to generate CDC's annual HAI national and state progress reports. EIP-HAIC data is used to help track the national burden of certain HAIs and track MRSA and CDI infections inside and outside of healthcare settings. Additional HAI and antibiotic stewardship metrics are located on CDC's Antibiotic Resistance and Patient Safety Portal (AR & PSP). Additional information on CDC's HAI prevention efforts and HAI-AR metrics can be found on CDC's website.