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 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 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 several prevention and reduction strategies.
Of course, there is undoubtedly a combination of factors at play here. In short, these findings suggest that hospitals have been working tirelessly to minimize patients' risk of HAIs through the implementation of evidence-based practices. The focus on evidence-based care in combination with greater consistency of surveillance practices and increasing multidisciplinary engagement among hospital staff likely had the most significant 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:
- Local risk assessment: it’s important to study current HAI problem areas in the hospital, perform root cause analyses to identify trends in care gaps, and review and adjust policies/procedures as necessary. Develop measurable goals for monitoring program impact(s) and develop action strategies for education and remediation of inadequate prevention patterns.
- Real-time surveillance technology: hospitals must be able to monitor for at-risk patients, prevent HAIs, and continuously look for performance improvement opportunities. Retrospective reporting capabilities allow hospitals to comply with regulatory reporting and produce metrics to guide and measure program performance.
- Regulatory requirement education: the team must be apprised of both current and future state hospital practices, which may adversely impact reportable HAIs. For example, hospitals should evaluate and confirm appropriate specimen collection and testing protocols for Clostridioides difficile. Additionally, diagnostic stewardship should also be embraced for urine and blood cultures to avoid inappropriate testing practices, which may artificially inflate HAI events based on reportable infection criteria.
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 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 hospital staff engagement, 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.