Status of infection surveillance and control programs in the United States, 1992-1996

Background: Nosocomial infections have been recognized as a source of morbi dity and mortality throughout the world for several decades. In the United States, an estimated 2.1 million nosocomial infections occur annually in ac ute care hospitals alone. Infection surveillance and control programs (ISCP s) play a vital role in addressing this problem, but no national studies ha ve described the status and composition of these programs since the 1970s. Methods: In January 1997, a voluntary survey was sent by mail to members of the Association for Professionals in Infection Control and Epidemiology, I nc. Only one response per facility was requested. The survey asked for info rmation for the years 1992 to 1996 (study period), and questions pertained to characteristics of the health care facility in which the respondent work ed, characteristics of the ISCP and its personnel, and the overall level of administration support for infection control activities. Results: Completed questionnaires were received from personnel at 187 healt h care facilities located in 40 states and the District of Columbia. The ma jority (76.5%) of responding facilities were nongovernment owned, and 57.2% were classified as general acute care facilities. The number of licensed b eds at these facilities remained stable throughout the study period, but al l other measures of facility size and activity (eg, number of patient days and number of nurses) decreased by as much as 28.9%. In 1992, ISCPs were mo st likely to be organizationally located in the Nursing Department, but by 1996, many had been transferred to departments of Medical Records, Quality Assurance, or Risk Management. Throughout the course of the study period, t he number of facilities performing surveillance for health care-associated infections in outpatient settings increased by 44.0%, from 100 to 144. In 1 996, only 47.6% of facilities had a hospital epidemiologist (HE), and HEs d evoted a median of 15% or less of their time to infection control activitie s. For the most part, HEs were trained in infectious diseases, and few had certification in infection control. Infection control professionals (ICPs) were much more common than were HEs (ICPs were reported at 97.9% of respond ents' facilities in 1996), and they spent the majority (80% in 1996) of the ir time on infection control activities. During the course of the study per iod, increasing numbers of facilities had ICPs who had certification in inf ection control. Furthermore, most respondents did not report a change over time in the level of administration support for infection control activitie s. Conclusions: Health care delivery has changed dramatically during the past 20 years. This study presents an updated description of ISCPs in the United States. Our results illustrate several changing parameters, such as depart mental shifts and increased outpatient surveillance, that reflect adjustmen ts in health care priorities during the study period. As the transformation of the health care system continues, continued evaluation of the status of ISCPs on a national level will be necessary. Diligent monitoring, proactiv e measures, and collaboration between infection control organizations and g overnment agencies will be vital for the prevention and control of health c are-associated infections in the future.