Skip to main content Accessibility help

Device-Associated Infection Rates, Device Utilization, and Antimicrobial Resistance in Long-Term Acute Care Hospitals Reporting to the National Healthcare Safely Network, 2010

  • Amit S. Chitnis (a1) (a2), Jonathan R. Edwards (a1), Phillip M. Ricks (a1), Dawn M. Sievert (a1), Scott K. Fridkin (a1) and Carolyn V. Gould (a1)...



To evaluate national data on healthcare-associated infections (HAIs), device utilization, and antimicrobial resistance in long-term acute care hospitals (LTACHs).

Design and Setting.

Comparison of data from LTACHs and from medical and medical-surgical intensive care units (ICUs) in short-stay acute care hospitals reporting to the National Healthcare Safety Network (NHSN) during 2010.


Rates of central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and ventilator-associated pneumonia (VAP) as well as device utilization ratios were calculated. For each HAI, pathogen profiles and antimicrobial resistance prevalence were evaluated. Comparisons were made using Poisson regression and the Mood median and x2 tests.


In 2010, 104 LTACHs reported CLABSIs and 57 reported CAUTIs and VAP to the NHSN. Median CLABSI rates in LTACHs (1.25 events per 1,000 device-days reported; range, 0.0-5.96) were comparable to rates in major teaching ICUs and were higher than those in other ICUs. CAUTI rates in LTACHs (median, 2.61; range, 0.0-9.92) were higher and VAP rates (median, 0.0; range, 0.0-3.29) were generally lower than those in ICUs. Central line utilization in LTACHs was higher than that in ICUs, whereas urinary catheter and ventilator utilization was lower. Methicillin resistance among Staphylococcus aureus CLABSIs (83%) and vancomycin resistance among Enterococcus faecalis CAUTIs (44%) were higher in LTACHs than in ICUs. Multidrug resistance among Pseudomonas aeruginosa CAUTIs (25%) was higher in LTACHs than in most ICUs.


CLABSIs and CAUTIs associated with multidrug-resistant organisms present a challenge in LTACHs. Continued HAI surveillance with pathogen-level data can guide prevention efforts in LTACHs.

Infect Control Hosp Epidemiol 2012;33(10):993-1000


Corresponding author

1600 Clifton Road, MS A-35, Atlanta, GA 30333 (


Hide All
1.Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy, Published 2011. Accessed January 9, 2012.
2.Eskildsen, MA. Long-term acute care: a review of the literature. J Am Geriatr Soc 2007;55:775779.
3.Munoz-Price, LS. Long-term acute care hospitals. Clin Infect Dis 2009;49:438443.
4.Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27:920925.
5.Furuno, JP, Hebden, JN, Standiford, HC, et al.Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter bau-mannii in a long-term acute care facility. Am J Infect Control 2008;36:468471.
6.Munoz-Price, LS, Stemer, A. Four years of surveillance cultures at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31:5963.
7.Lin, MY, Lyles, RD, Lolans, K, et al. Prevalence of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaciae (KPC) among adult patients in intensive care units (ICUs) and long-term acute care hospitals (LTACHs) in the Chicago region. Presented at: 49th annual meeting of the Infectious Diseases Society of America; October 20-23, 2011; Boston. Abstract 396.
8.Wolfenden, LL, Anderson, G, Veledar, E, Srinivasan, A. Catheter-associated bloodstream infections in 2 long-term acute care hospitals. Infect Control Hosp Epidemiol 2007;28:105106.
9.Salgado, CD, Chinnes, L, Paczesny, TH, Cantey, JR. Increased rate of catheter-related bloodstream infection associated with use of a needleless mechanical valve device at a long-term acute care hospital. Infect Control Hosp Epidemiol 2007;28:684688.
10.Walkey, AJ, Reardon, CC, Sulis, CA, Nace, N, Joyce-Brady, M. Epidemiology of ventilator-associated pneumonia in a long-term acute care hospital. Infect Control Hosp Epidemiol 2009;30: 319324.
11.Munoz-Price, LS, Hota, B, Sterner, A, Weinstein, RA. Prevention of bloodstream infections by use of daily Chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009;30:10311035.
12.Stephens, C, Francis, SJ, Abell, V, DiPersio, JR, Wells, P. Emergence of resistant Acinetobacter baumannii in critically ill patients within an acute care teaching hospital and a long-term acute care hospital. Am J Infect Control 2007;35:212215.
13.Endimiani, A, DePasquale, JM, Forerro, S, et al.Emergence of bla KPC-containing Klebsiella pneumonia in a long-term acute care hospital: a new challenge to our healthcare system. J Antimicrob Chemother 2009;64:11021110.
14.Won, SY, Munoz-Price, LS, Lolans, K, et al.Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53:532540.
15.Centers for Disease Control and Prevention. The National Healthcare Safety Network (NHSN) Patient Safety Manual Accessed January 9, 2012.
16.Dudeck, MA, Horan, TC, Peterson, KD, et al.National Healthcare Safety Network (NHSN) report, data summary for 2010, device-associated module. Am J Infect Control 2011;39:798816.
17.Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: 18th Informational Supplement. CLSI document M100-S18. Wayne, PA: CLSI, 2008.
18.Centers for Disease Control and Prevention. Vital signs: central line-associated bloodstream infections—United States, 2001, 2008, 2009. MMWR Morb Mortal Wkly Rep 2011;60:243248.
19.Burton, DC, Edwards, JR, Horan, TC, Jernigan, JA, Fridkin, SK. Methicillin-resistant Staphylococcus aureus central line–associated bloodstream infections in US intensive care units, 1997-2007. JAMA 2009;301:727736.
20.Burton, DC, Edwards, JR, Srinivasan, A, Fridkin, SK, Gould, CV. Trends in catheter-associated urinary tract infections in adult intensive care units—United States, 1990-2007. Infect Control Hosp Epidemiol 2011;32:748756.
21.Centers for Medicare and Medicaid Services 1518-F. Hospital Inpatient Prospective Payment System for acute care hospitals and the long-term care hospitals prospective payment system and FY 2012 rates; Hospitals' FTE resident caps for graduate medical education payment. 76 Federal Register 160 (August 18, 2011), pp. 51476-51846. Accessed January 9, 2012.
22.Munoz-Price, LS, Hayden, MK, Lolans, K, et al.Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae in a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31:341347.
23.Centers for Disease Control and Prevention. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. Accessed January 9, 2012.
24.Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58:256260.
25.Donlan, RM. Biofilm elimination on intravascular catheters: important considerations for the infectious disease practitioner. Clin Infect Dis 2011;52:10381045.
26.Nseir, S, Pompeo, C, Jozefowicz, E, et al.Relationship between tracheostomy and ventilator-associated pneumonia: a case-control study. Eur Respir J 2007;30:314320.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed