A point-prevalence survey conducted in the United States in 2011 indicated that 4% of hospitalized patients had a healthcare-associated infection. The survey was repeated in 2015 to assess changes in the prevalence of healthcare-associated infections during a period of national attention to the prevention of such infections and identify infections that may need more attention as well as changes over time that can help healthcare professionals understand the success of infection-prevention efforts.

For work published in the New England Journal of Medicine, Shelley S. Magill, MD, PhD, and colleagues sought to determine the percentage of all patients in the survey who had a healthcare-associated infection, the various types of infections and pathogens, and the frequency of each. In 2015, a 12,299 patients in 199 hospitals were surveyed, whereas 11,282 patients were surveyed in 183 hospitals in 2011. The hospitals selected a survey date between May and September 2015, and a random sample of patients was identified using the morning hospital inpatient census on the selected survey date.

Fewer patients had healthcare-associated infections in 2015 (3.2%) than in 2011 (4.0%), largely owing to reductions in the prevalence of surgical-site and urinary tract infections. Pneumonia, gastrointestinal infections, and surgical-site infections were the most common healthcare-associated infections during the project period. Patients’ risk of having a healthcare-associated infection was 16% lower in 2015 than in 2011, after adjustment for age, presence of devices, days from admission to survey, and site of care hospital size.

“The findings of these surveys provide additional evidence that improvement is possible, and we can successfully reduce the occurrence of these infections and improve patient safety in healthcare settings,” says Dr. Magill. “Hopefully, this can motivate physicians and other healthcare professionals to continue their work to ensure that infection control practices are being followed. However, the survey highlights some infection types for which more attention is needed. For example, we didn’t see changes in the prevalence of C. difficile, which was once again the most commonly reported pathogen, indicating that continued work on antimicrobial stewardship and improving the way antimicrobial medications are prescribed in hospitals is critical—as well as on ensuring implementation of infection control measures to prevent the transmission of C. difficile.”


Magill S, O’Leary E, Janelle S, et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. N Engl J Med. 2018; 379:1732-1744. Available at