National HAI Targets & Metrics

The U.S. Department of Health and Human Services (HHS) announced new targets for the national acute care hospital metrics for the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan) in October 2016. The targets use data from calendar year 2015 as a baseline — and are in effect for a 5-year period from 2015 to 2020. These new targets replace the previous targets that expired in December 2013. These target goals for reduction of health care-associated infections (HAIs) are ambitious, but achievable.

The measures track population-based harm from HAIs at the national level. These measures address the following goals from the HAI Action Plan:

Note: The initial set of acute care hospital targets and metrics included a measure on Surgical Care Improvement Project (SCIP) processes. That measure is no longer part of the HAI Action Plan because these processes are now widely accepted as standards of practice.

Table 1: 2020 National Acute Care Hospital HAI Metrics

Measure (and data source)

Progress made by 2016

2020 Target (from 2015 baseline)


10% reduction

50% reduction


6% relative reduction

25% reduction

Invasive MRSA (NHSN/EIP2)

8% reduction

50% reduction

Hospital-onset MRSA (NHSN)

6% reduction

50% reduction

Hospital-onset CDI (NHSN)

7% reduction

30% reduction


Data to be released in 2018

30% reduction

Clostridium difficilehospitalizations (HCUP)3

Data pending release

30% reduction

1 NHSN: The National Healthcare Safety Network, of the Centers for Disease Control and Prevention (CDC), is the nation’s most widely used health care-associated infection tracking system. Since 2009, infection data has been reported to the NHSN to track the national progress of the reduction of HAIs.

2 EIP: CDC’s Healthcare-Associated Infections - Community Interface (HAIC), a component of the Emerging Infections Program, is an active population-based surveillance system for HAIs caused by pathogens such as MRSA. These EIP sites also use the NHSN to perform time-limited evaluations of HAIC data among NHSN facilities participating in the EIP NHSN network.

3 HCUP: AHRQ’s Healthcare Cost and Utilization Project is the nation’s most comprehensive source of hospital data. HCUP data is used to track hospitalizations due to Clostridium difficile.

Progress in reducing HAIs, as assessed by NHSN data, is tracked using a standardized infection ratio (SIR). The SIR compares the number of HAIs observed to the predicted number of infections. The predicted number is a risk-adjusted estimate that is determined using national baseline data. Health care facilities, state and local health departments, and federal agencies like the Centers for Medicare and Medicaid Services (CMS) can use NHSN data to identify problem areas and target HAI prevention efforts within specific facilities, regions, and states.

CDC’s report, Healthcare-Associated Infections in the United States, 2006-2016: A Story of Progress, provides a description of the NHSN data and a reflection on several years of national progress towards eliminating major HAIs in acute care hospitals.

Progress in reducing Clostridium difficile hospitalizations is tracked using AHRQ’s HCUP State Inpatient Databases, beginning in 2010 (the date at which complete data was available for whether the data was present on admission). A description of the HCUP data, methodology and progress toward eliminating CDI in nonfederal short-term general and other specialty hospitals can be found at AHRQ’s report on Clostridium difficile Hospitalizations, 2010-2014 and 2011-2015.

Antibiotic Stewardship

Antibiotic overuse has contributed to the growing problem of CDI and antibiotic resistance. Although progress has been made, more work is needed. In response to this challenge, AHRQ, CDC, and CMS have developed initiatives for antibiotic stewardship. The Office of Disease Prevention and Health Promotion has published a new phase to the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination describing the federal health agencies coordinated response to supporting the practice of antibiotic stewardship.