Posted on April 15, 2019
Healthcare-associated infections (HAIs) have stymied the modern healthcare system, resulting in the loss of tens of thousands of lives and billions of dollars in costs in the United States each year.1 The prevalence of HAIs has been concerning, with the Centers for Disease Control and Prevention (CDC) estimating that at any given time, 1 in 31 hospital patients have an HAI.2
Things are apparently looking up.
The recently released 2017 National and State Healthcare-Associated Infections Progress Report from the CDC provides data on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), surgical site infections (SSIs), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream events, and Clostridioides difficile (C. difficile) events. The report presents a rosier picture than previous reports, noting the progress that has been made in reducing HAIs.
These strides are incredibly important. Healthcare-associated infection is costly and causes substantial morbidity and mortality. In addition, the substantial economic costs of HAIs will likely be increasingly borne by hospitals, because the Centers for Medicare and Medicaid Services no longer reimburses hospitals for the extra cost of caring for patients who develop certain infections during hospitalization.
The report notes statistically significant decreases in HAIs in acute care hospitals, long-term acute care hospitals and inpatient rehabilitation facilities, particularly with regard to C. difficile events, which saw 20%+ reductions in all settings.
These may reflect a number of prevention and reduction strategies.
Of course, there is certainly a combination of factors at play here. In short, these findings suggest that hospitals have been working tirelessly to minimize patient risk of HAIs through implementation of evidence-based practices. This, in combination with a greater consistency of surveillance practices and increasing multidisciplinary engagement among hospital staff, likely had the greatest role in these findings.
The improvements likely also were influenced by the HHS Action Plan to Prevent Healthcare-Associated Infections, developed by the U.S. Department of Health and Human Services (HHS) as a roadmap for prevention.3
How can hospitals keep the momentum?
While the new CDC report is encouraging, hospitals can’t afford to take their foot off the gas in terms of prevention and reduction. Clinical leadership should first assess their infection prevention initiatives by looking at the teams and technology they have in place. Key elements of a successful infection prevention program include:
From my perspective, hospitals should first prioritize areas of opportunity through an annual plan and risk assessment. It should include a focus on minimizing patient risk (e.g. lower device utilization) or a more judicious use of broad-spectrum antimicrobials to lower the risk of Clostridioides difficile infections. The bottom line is that hospitals will each have customized strategies to address areas of need in their local settings. These strategies will no doubt include heightened engagement of hospital staff, striving for continued consistency of surveillance procedures and using evidence-based practices to drive prolonged improvements.
1. Healthcare-Associated Infections. Overview. Office of Disease Prevention and Health Promotion. https://health.gov/hcq/prevent-hai.asp. Accessed March 25, 2019.
2. HAI and Antibiotic Use Prevalence Survey. Centers for Disease Control and Prevention. https://www.cdc.gov/hai/eip/antibiotic-use.html. Accessed March 25, 2019.
3. Preventing Healthcare-Associated Infections. Centers for Disease Control and Prevention. https://www.cdc.gov/hai/prevent/prevention.html. Accessed March 26, 2019.
Written for clinicians