CDC Eastern Massachusetts Prevention Epicenter III

Epicenter III

The Epicenter III project evaluates five strategies for preventing healthcare associated infections. These strategies target common, high morbidity, and high cost complications of medical care, including infections caused by methicillin-resistant Staphylococcus aureus, ventilator associated pneumonia, and hospital-based outbreaks caused by many different kinds of pathogens. We have developed an extensive network of partners in academic and community hospitals, nursing homes, outpatient clinics, and microbiology laboratory data systems that represent local, regional, and national collaborations to address both current and future research needs to reduce healthcare associated infections.

Epicenter III Sepsis Supplement

Sepsis, the syndrome of dysregulated inflammation that occurs with severe infection, is a leading cause of death, disability, and cost to the healthcare system. Multiple studies suggest a surge in the incidence and burden of sepsis over the past several decades.  The Centers for Disease Control and Prevention, for example, has reported that U.S. sepsis rates doubled between 2000 and 2008.  However, interpretation of this trend, and our understanding of sepsis epidemiology in general, is hindered by major limitations in sepsis diagnosis and surveillance. Almost all epidemiologic studies of sepsis are based on claims data, which can be biased by changing coding systems, changes in sepsis awareness in light of high-profile campaigns and influential studies, and increasing financial incentives to code for more complexity.  These problems are compounded by subjective components in the “gold standard” consensus clinical definition of sepsis, which grant clinicians and hospitals broad discretion when diagnosing and coding for sepsis. 

To address these important issues, we have proposed a multicenter investigation in which we will collaborate with Washington University will perform complementary and collaborative research projects to better delineate the epidemiology of sepsis, and to explore the feasibility of developing objective surveillance definitions suitable for tracking population-level sepsis rates.

Sepsis Supplement Related Publications

Rhee C, Murphy MV, Li L, Platt R, Klompas M, . Comparison of trends in sepsis incidence and coding using administrative claims versus objective clinical data. Clin Infect Dis. 2015 Jan 1;60(1):88-95. Epub 2014 Sep 25.

Rhee C, Gohil S, Klompas M. Regulatory mandates for sepsis care--reasons for caution. N Engl J Med. 2014 May 1;370(18):1673-6. Epub 2014 Apr 16. 

Rhee C1, Murphy MV, Li L, Platt R, Klompas M; Centers for Disease Control and Prevention Prevention Epicenters Program.  Lactate Testing in Suspected Sepsis: Trends and Predictors of Failure to Measure Levels.  Crit Care Med. Epub 2015 May 8.

Rhee C, Murphy MV, Li L, Platt R, Klompas M, . Improving documentation and coding for acute organ dysfunction biases estimates of changing sepsis severity and burden: a retrospective study. Crit Care. 2015 Sep 14. [Epub ahead of print].

Rhee C, Klompas M, Tamburini FB, Fremin BJ, Chea N, Epstein L, Halpin AL, Guh A, Gallen R, Coulliette A, Gee J, Hsieh C, Desjardins CA, Pedamullu CS, DeAngelo DJ, Manzo VE, Folkerth RD, Milner DA, Pecora N, Osborne M, Chalifoux-Judge D, Bhatt AS, Yokoe DS. Epidemiologic Investigation of a Cluster of Neuroinvasive Bacillus cereus Infections in 5 Patients With Acute Myelogenous Leukemia. Open Forum Infect Dis. ; 2(3):ofv096.

Epicenter III Related Publications

Rhee C, Murphy MV, Li L, Platt R, Klompas M, . Lactate Testing in Suspected Sepsis: Trends and Predictors of Failure to Measure Levels. Crit Care Med. 2015 May 8. [Epub ahead of print].

van Mourik MS, Moons KG, , Murphy MV, Bonten MJ, Klompas M. Severity of Disease Estimation and Risk-Adjustment for Comparison of Outcomes in Mechanically Ventilated Patients Using Electronic Routine Care Data. Infect Control Hosp Epidemiol. 2015 Apr 17. [Epub ahead of print].

Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, Sinkowitz-Cochran R, Ely EW, Jernigan J, Magill S, Lyles R, O'Neil C, Kitch BT, Arrington E, Balas MC, Kleinman K, Bruce C, Lankiewicz J, Murphy MV, E Cox C, Lautenbach E, Sexton D, Fraser V, Weinstein RA, Platt R, . The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med. 2015 Feb 1;191(3):292-301.

Stevens JP, Silva G, Gillis J, Novack V, Talmor D, Klompas M, Howell MD. Automated surveillance for ventilator-associated events. Chest. 2014 Dec;146(6):1612-8.

Klompas M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Curr Infect Dis Rep. 2014 Oct;16(10):430.

Rhee C, Murphy MV, Li L, Platt R, Klompas M, . Comparison of trends in sepsis incidence and coding using administrative claims versus objective clinical data. Clin Infect Dis. 2015 Jan 1;60(1):88-95. Epub 2014 Sep 25.

Lewis SC, Li L, Murphy MV, Klompas M, . Risk factors for ventilator-associated events: a case-control multivariable analysis. Crit Care Med. 2014 Aug;42(8):1839-48.

Klompas M, Speck K, Howell MD, Greene LR, Berenholtz SM. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. JAMA Intern Med. 2014 May;174(5):751-61.

Rhee C, Gohil S, Klompas M. Regulatory mandates for sepsis care--reasons for caution. N Engl J Med. 2014 May 1;370(18):1673-6. Epub 2014 Apr 16.

Klompas M, Kleinman K, Murphy MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol. 2014 May;35(5):502-10. Epub 2014 Mar 14.

Muscedere J, Sinuff T, Heyland DK, Dodek PM, Keenan SP, Wood G, Jiang X, Day AG, Laporta D, Klompas M, . The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated. Chest. 2013 Nov;144(5):1453-60.

Klompas M. Ventilator-associated events surveillance: a patient safety opportunity. Curr Opin Crit Care. 2013 Oct;19(5):424-31.

Klompas M. Complications of mechanical ventilation--the CDC's new surveillance paradigm. N Engl J Med. 2013 Apr 18;368(16):1472-5.

Klompas M. What can we learn from international ventilator-associated pneumonia rates?. Crit Care Med. 2012 Dec;40(12):3303-4.

Klompas M, Magill S, Robicsek A, Strymish JM, Kleinman K, Evans RS, Lloyd JF, Khan Y, Yokoe DS, Stevenson K, Samore M, Platt R. Objective surveillance definitions for ventilator-associated pneumonia. Crit Care Med. 2012;40(12):3154-61.

Hayashi Y, Morisawa K, Klompas M, Jones M, Bandeshe H, Boots R, Lipman J, Paterson DL. Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units. Clin Infect Dis. 2013 Feb;56(4):471-7. Epub 2012 Nov 1.

Klompas M, Kleinman KP, Karcz A. Variability in mean duration of mechanical ventilation among community hospitals. Infect Control Hosp Epidemiol. 2012 Jun;33(6):635-7. Epub 2012 Apr 24.

Klompas M, Kleinman K, Khan Y, Evans RS, Lloyd JF, Stevenson K, Samore M, Platt R. Rapid and reproducible surveillance for ventilator-associated pneumonia. Clin Infect Dis. 2012 1;54(3):370-7.

Klompas M. Interobserver variability in ventilator-associated pneumonia surveillance. Am J Infect Control. 2010 Apr;38(3):237-9. Epub 2010 Feb 19.

Klompas M, Kulldorff M, Platt R. Risk of misleading ventilator-associated pneumonia rates with use of standard clinical and microbiological criteria. Clin Infect Dis. 2008 May 1;46(9):1443-6.

Klompas M, Kleinman K, Platt R. Development of an algorithm for surveillance of ventilator-associated pneumonia with electronic data and comparison of algorithm results with clinician diagnoses . Infect Control Hosp Epidemiol. 2008 Jan;29(1):31-7.

Related Links

CDC Prevention Epicenter Program

Principal Investigator: Richard Platt

Funder: Centers for Disease Control and Prevention