Welcome to the 2023 Annual Report of Healthcare Associated Infections in Utah

We recommend reading through the light green tabs first, which include the executive summary, foreword, and interpreting HAI data. Then, click on the dark purple Utah HAIs tab above to see drop down data pages on each HAI. The last About the data tab goes through the introduction, how Utah HAI data is collected, data quality validation, validation conclusions, references, and acknowledgements.

In the Overview and events tables, column headers may be underlined with light blue. Hover over these to read term definitions.

Thank you!

What does the standardized infection ratio (SIR) mean?

The SIR is the ratio of the observed number of infections (events) to the number of predicted infections (events) for a specific time period.

What is the national baseline?

Data reported to the National Healthcare Safety Network (NHSN) by all facilities during a set time period is combined to make the national baseline. The national baseline predicts the number of infections expected to happen in a hospital, state, or in the country. In the 2023 National and State Healthcare-Associated Infections Progress Report, the number of predicted infections is an estimate tailored for each facility using predictors compared to the 2015 baseline time period. HAI predictors include the number of infections in the community or the total number of patient days.

Examples: 45 observed cases/30 expected cases: the SIR is 45/30 = 1.5 Since 1.5 is 50% greater than 1, the SIR indicated an excess of 50%.

15 observed cases/30 expected cases: the SIR is 15/30 = 0.5 Since 0.5 is 50% less than 1, a SIR = 0.5 would indicate a 50% decrease.

To improve precision, SIRs are only calculated when the number of predicted infections is greater than 1. This rule was devised by NHSN to avoid calculating and interpreting statistically imprecise SIRs, which often have extreme values.

Key:

Statistically FEWER infections than the national aggregate data

Statistically MORE infections than the national aggregate data

Predicted to have less than one infection for the year, and had ZERO infections, as defined by NHSN, in 2023

Predicted to have less than one infection for the year, but had one or more infections, as defined by NHSN, in 2023

NOT statistically different from the national aggregate data

Background

Healthcare-associated infections (HAIs) are infections patients get during treatment for something else in a healthcare setting. A patient can get HAIs anywhere healthcare is given, including inpatient acute care hospitals (ACH), outpatient settings (out-patient surgical centers and dialysis facilities), and long-term care facilities (nursing homes and rehabilitation centers). HAIs may be caused by any infectious agent, including bacteria, fungi, viruses, and less common pathogens.

Centers for Medicare & Medicaid Services (CMS) requires healthcare facilities to report HAIs to the National Healthcare Safety Network (NHSN). Reportable HAIs include:

• central-line associated bloodstream infections (CLABSIs)
• catheter-associated urinary tract infections (CAUTIs)
• some surgical site infections (SSIs)
• methicillin-resistant Staphylococcus aureus (MRSA) bacteremia infections
• Clostridioides difficile-associated infections (CDIs).
  

Economic studies estimate HAI treatments cost more than $9 billion each year (Scott et al., 2019). On top of the cost of treatment, HAIs can have severe emotional, financial, and medical impacts for the person affected (HHS, 2022). Each day, approximately 1 in 31 U.S. hospitalized patients has at least 1 infection related to their care. These infections can lead to severe illness and even death. Tens of thousands of lives are lost each year, which argues the need to improve infection prevention practices in U.S. healthcare facilities (Agency for Healthcare Research and Quality [AHRQ], 2019; CDC, 2018).

The mission of the DHHS HAI/AR program is to prevent healthcare-associated infections and the spread of antimicrobial-resistant germs as we work with partners, track and respond to outbreaks, analyze data, educate medical staff, and promote policy change. HAI/AR creates this yearly report to record and analyze HAI trends in Utah healthcare facilities. The NHSN statistics calculator was used to confirm statistical significance. This calculator provides a relative ratio of SIRs, a two-tailed p-value, and a 95% confidence interval.

The information in this report has several weaknesses and should be treated as an overview of HAIs in Utah. First, the data comes from NHSN and are self-reported by healthcare facilities. DHHS has limited ability to validate this data. Also, CMS reporting rules vary for each disease/condition based on the facility type. Lastly, data does not reflect variations of illness complexity and facility settings.

2023 HAI findings in Utah and the US

HAIs may be caused by medical devices used when patients are ill, such as a central line or urinary catheter (Marschall et al., 2014). The risk of infection goes up the longer these devices are in the body (U.S. Department of Health and Human Services [HHS], 2022). In 2023, U.S. ACHs saw decreases in annual rates for CLABSIs by 13% and CAUTIs by 11% when compared with 2022 (Centers for Disease Control and Prevention [CDC], 2024a). In Utah, decreases were also seen for both CLABSIs and CAUTIs in ACHs when compared to 2022 (19% and 17%, respectively.) This decrease can also be observed when data from all location settings are combined (7% for CLABSI and 15% for CAUTIs overall). However, none of these decreases were found to be significant when compared with Utah’s 2022 data. The combined CLABSI SIR for all locations and the decrease specific to ACHs were not found to be significant in Utah (p=0.61 and p=0.16, respectively). Similarly, the combined CAUTI SIR for all locations and the decrease specific to ACHs were not found to be significant in Utah (p=0.24 and p=0.21, respectively) (CDC National Healthcare Safety Network [NHSN], 2024).

HAIs may also occur as a result of complications after a surgical procedure or when infection control practices, such as hand washing, are not followed (Anderson et al., 2014). While preventive treatment and infection control has improved, infections caused by these factors make up 20% of all HAIs nationwide (CDC NHSN, 2025). According to the 2023 National and State Healthcare-Associated Infections Progress Report, there were no significant changes in colon surgery SSIs at the national level between 2022 and 2023 (CDC, 2024a). Utah saw a 16% decrease which was not statistically significant when compared with Utah’s 2022 SIR (p= 0.37). The 2023 SIRs for abdominal hysterectomy surgery SSIs, however, increased for both Utah and the U.S. when compared to 2022 (10% and 8%, respectively) (CDC NHSN, 2024; CDC, 2024a). In Utah, this observed increase was not found to be statistically significant (p=0.76).

MRSA is a bacterium resistant to many antibiotics and is common in healthcare facilities. In the community, most MRSA infections are skin infections. In medical facilities, MRSA may cause life-threatening bloodstream (or bacteremia) infections, endocarditis, pneumonia, and surgical site infections (Calfee et al., 2014). Although meaningful progress has been made to reduce MRSA bloodstream infections, MRSA still poses a clinical threat, with high morbidity and mortality (Turner et al., 2019). In the U.S., the number of reported MRSA bacteremia cases decreased by 16% from 2022 to 2023 (CDC, 2024a). Utah, by comparison, experienced a 10% increase though not statistically significant (p=0.69). However, it is worth noting that 23 ACHs in Utah reported 0 cases of MRSA bacteremia in 2022 (CDC NHSN, 2024).

Patients who receive medical care and take antibiotics for long periods of time are more susceptible to HAIs, such as Clostridioides difficile (CDIs). Although antibiotics effectively eliminate bacterial infections, they also attack the microbiome that protects the body against harmful infections. Antibiotic misuse and resulting antibiotic resistance has driven the growth of CDIs and the emergence of new strains (Spigaglia, 2016). CDIs are estimated to cause almost half a million infections in the U.S. each year, and now rival MRSA as the most common organism to cause HAIs in the U.S. (CDC 2022b; Dubberke et al., 2014). In addition, one in 11 patients older than age 65 with a CDI die within a month of diagnosis (CDC, 2022b). Fortunately, there was a 13% decrease in hospital onset CDIs in U.S. ACHs between 2022 and 2023 (CDC, 2024a). Utah experienced a 9% decrease; however, the difference in SIRs was not found to be statistically significant (p= 0.23) (CDC NHSN, 2024).

Patients who get dialysis treatment (a treatment for inadequate kidney function) also have an increased risk for acquiring HAIs. They are at high risk because this artificial process to get rid of waste and fluid in the body needs regular access to the bloodstream. Dialysis patients may have weakened immune systems, which also increases their risk for infection (CDC, 2020). The SIRs of dialysis event bloodstream infections (BSI) saw a significant decrease from 2014 to 2019 both nationally and in Utah (CDC, 2024b; CDC NHSN, 2024). The decrease reflects the efforts of outpatient dialysis centers, federal agencies, and professional societies to equitably apply interventions across all dialysis facilities. Currently, national data on dialysis BSI SIRs is not available for 2023. However, when comparing Utah dialysis BSI event SIRs from 2022 to 2023, there was an 18% increase observed, though not statistically significant (p= 0.34) (CDC NHSN, 2024). This increase is likely because more facilities have started to share their NHSN data to the state of Utah. This is important for data accuracy in this annual report as well as to help guide where to implement targeted infection prevention efforts within the state.

Findings in this report stress the importance of action from public health and healthcare facilities to eliminate infections that commonly threaten patients, especially during times of emergent crises. DHHS will continue to track and respond to outbreaks, analyze data, improve education, and promote policy change.

Background

The Department of Health and Human Services (DHHS) is required by Utah Title 26B-7-221 to validate the data reported to NHSN. Under guidance from the CDC, catheter-associated urinary tract infections (CAUTIs) were chosen for 2023 NHSN data validations. The focus of these validations was to gauge whether hospitals accurately report CAUTIs and monitor for these infections. The DHHS HAI/AR program did validations at hospitals and dialysis centers across Utah. Facilities were randomly chosen, as guided by the CDC’s NHSN toolkit for 2023. This helped make the sample as representative as possible.

Validations involve comparing data reported to NHSN and DHHS audit findings. Comparison results give us the chance to improve accuracy and completeness of NHSN reporting. Please note that our findings should not be applied to all healthcare facilities in Utah. Also, overall findings are not a true measure of NHSN data quality.

Procedure

An on-site medical record audit was conducted at each of the 6 acute care hospitals (ACHs) chosen. A limit of 20 patient charts were reviewed during any visit. Up to 10 of these charts were patients who had a reported CAUTI in 2023. Another 10 patients had a positive urine culture but did not meet CAUTI criteria. The purpose of these reviews was to evaluate if CAUTI criteria is correctly being used and to decide if any infections were missed. Only only identified one error in CAUTIreporting.

After the review of medical records, the HAI/AR team interviewed at least 1 member of the infection prevention staff. This interview asked about infection surveillance methods, data collection, and training and education for staff on NHSN criteria. The team discussed results with the facility to improve HAI surveillance and reporting. We also provided infection prevention and control resources to help with general staff education.

References