Along with Oregon’s state healthcare-associated infections (HAI)-related activities, which include mandated reporting of specific HAIs, validation of reported data, a multi-hospital collaborative focused on prevention of HAIs, and multiple research projects, there are a number of state-level activities that are part of the Oregon Emerging Infections Program (EIP) focused on the surveillance and prevention of healthcare-associated infections.

These projects include determining overall HAI prevalence, investigating ways to make HAI surveillance easier for hospitals, and conducting surveillance for specific HAIs.

On this page:

Surveillance Activities • Special Studies • Publications

Ongoing HAI Surveillance Activities

Candidemia • MuGSI • C. difficile

Healthcare-Associated Infection Surveillance 

Candidemia Surveillance 

Candida species are part of the normal, commensal flora of humans, and are commonly found in the gastrointestinal and female genital tract. While in healthy, immunocompetent hosts, invasive disease due to Candida spp. is unusual, Candida spp. can be deadly pathogens in hosts whose defenses are compromised by breaches in mucosal integrity, critical illness, and immunosuppressive drugs. With an increase in the availability and use of antifungal agents, emergence of resistance among invasive Candida spp. remains a significant concern.

The objectives of this study are to:

• Estimate the incidence of candidemia and prevalence of antifungal drug resistance
• Explore candidemia regional patterns and trends over time
• Provide data on risk factors and clinical outcomes of patients with candidemia in order to target prevention efforts

Methods:

• Microbiology records from hospital laboratories in the Portland tri-county region (Clackamas, Multnomah, and Washington counties) are reviewed monthly
• All Candida blood isolates are forwarded to the Division of Bacterial and Mycotic Diseases at CDC for speciation and antifungal susceptibility
• Medical records are reviewed for demographic, clinical, and risk factor information

 
View the Candidemia Surveillance Reports (pdf)  April 2013 | March 2013  | February 2013 | January 2013 | 
2011-2012 Biennial Report 

Multidrug-Resistant Gram-Negative Bacilli Surveillance Initiative (MuGSI)

Gram-negative bacilli (GNB) are bacteria that frequently cause infections in both healthcare and community settings. The emergence of antimicrobial resistance has raised the importance of these organisms as a public health problem, as new classes of antibiotics are not expected to be available for many years.

Infections with multidrug-resistant GNB (MDR GNB) have been identified with increasing frequency in people who are hospitalized or immunocompromised; these infections may not be treatable with any available antibiotics, or they may be treatable only with antibiotics that can cause kidney and nerve damage. MDR GNB are easily transmissible and present serious infection control and healthcare challenges. Recognizing the need for data to increase our understanding of this emerging problem, to define the population at risk, and to inform prevention efforts, Oregon has joined three other EIP sites in an active, laboratory-based surveillance project.

The objectives of this study are to:

• Evaluate the population-based incidence of carbapenem-nonsusceptibility among common strains of Enterobacteriaceae and Acinetobacter species and describe how the incidence changes over time
• Better characterize drug-resistant strains so as to inform prevention efforts
• Describe known resistance mechanisms among a subset of MDR GNB

Clostridium difficile Surveillance

Clostridium difficile is a toxin-producing interstitial bacterium that may cause illness in patients who have received prolonged courses of antimicrobials. This exposure disrupts the normal commensal flora of the colon, allowing C. difficile to flourish and produce toxins that cause diarrhea and more serious intestinal conditions such as colitis. Transmission of C. difficile occurs primarily in healthcare facilities, where environmental contamination by C. difficile spores and exposure to antimicrobial drugs are common.

The objectives of this study are to:

• Determine the population-based incidence of community- and healthcare-associated Clostridium difficile infections (CDI) among participating EIP sites
• Characterize C. difficile strains that are responsible for CDI in the population under surveillance with a focus on strains from community-associated cases
• Describe the epidemiology of community- and healthcare-associated CDI
• Generate hypotheses for future research using EIP CDI surveillance infrastructure

Surveillance for this project began in Klamath County with data collection May 2010.  Oregon EIP is currently working to expand CDI surveillance to other areas in Oregon.

HAI Special Studies

Oregon EIP Healthcare-Associated Infection Surveillance Special Studies

Denominator Simplification Project
Though surveillance of HAIs is very important for understanding and reducing the problem, it can take a large amount of time to collect complete data. Limited resources and inability to collect denominator data on a routine basis are recognized barriers to conducting HAI surveillance. As a result CDC, in collaboration with EIP designed the Denominator Simplification Project to find ways to collect this data efficiently. Abstract 

To see all Oregon Emerging Infections Program special studies go to EIP special studies.

HAI Publications / Papers / Presentations

Oregon EIP Healthcare-Associated Infection Surveillance Publications

Preliminary Results of a Healthcare-Associated Infection and Antimicrobial Use Prevalence Survey in 22 U.S. Acute Care Hospitals. Society for Healthcare Epidemiology of America (SHEA) annual meeting 2011. Go to results.

Evaluation of sampling denominator data to estimate central line days: Validation of methods to reduce data collection burden of NHSN. Society for Healthcare Epidemiology of America (SHEA) annual meeting 2011. Go to results.