When it comes to hospital-acquired infections (HAIs), too many clinicians believe they’re already ahead of infection control challenges.
Some organizations question the need for an updated infection prevention and control (IPC) program, but that skepticism means that leaders act quickly is even more important. New threats are always emerging, and robust infection prevention programs help reduce the chance of HAI infection and improve outcomes for all your patients.
This is especially true for programs that address today’s most pressing infection challenges to reduce variability in care. To help more organizations implement this type of program, we’ve pulled together these five key points for today’s IPC leaders.
1. COVID-19 has hampered efforts to halt hospital-acquired infections
Prior to the COVID-19 pandemic, healthcare-associated infections had been decreasing since 2015, reports the Center for Infectious Disease Research and Policy (CIDRAP). However, the strain of COVID-19 patient care and triage on hospitals and other facilities “clearly put a dent in those efforts,” CIDRAP states.
During the last quarter of 2019 and second quarter of 2020, facilities were exempt from reporting HAIs. To gain insight into the impact of COVID-19 on hospital-acquired infections, the CDC’s National Healthcare Safety Network (NHSN) examined quarterly data from across 12 states. They found significant increases in central line associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAE), and MRSA bacteremia compared to 2019, including a 47% increase in CLABSIs across location types and a 65% increase in ICUs.
IPC programs have been overwhelmed by the pandemic, leaving many under-resourced and some pushing non-COVID HAIs onto the back burner. Hospitals need resilient, sustainable, and high-performing infection prevention and control programs more than ever.
2. These infections cost the healthcare system billions each year
According to the CDC, HAIs directly cost US hospitals at least $28.4 billion each year. These costs are underscored by a $12.4 billion loss to society from early deaths and lost productivity. Of the total amount, anywhere between $5.7 and $31.5 billion is possibly preventable.
The losses appear even more stark at the individual hospital level. A 2020 study published in BMC Health Services Research found that HAIs were associated with increased consumption of resources, including blood tests, imaging, hospital days, and antibiotic days. They were also associated with a higher cost per case at $6,400 vs. a control of $2,376.
3. Less than half of HAIs involve devices or surgeries
A study from the New England Journal of Medicine (NEJM) found that device-associated infections (such as CAUTI, ventilator-associated pneumonia, and CLABSI) made up 25.6% of all HAIs, while surgical-site infections accounted for 21.8% of HAIs. So, what caused the 52.6% of HAIs that were not associated with devices or operative procedures?
One pathogen stands out. The bacterium Clostridioides difficile accounts for 12.1% of HAIs, notes the NEJM study. C. difficile is easily spread from person to person and caused an estimated 223,900 HAI cases and 12,800 deaths in 2017, according to the CDC’s 2019 Antibiotic/Antimicrobial Resistance threat report.
C. difficile is resistant to multiple antibiotics used in clinical settings, including aminoglycosides, lincomycin, tetracyclines, erythromycin, clindamycin, penicillin, cephalosporins, and fluoroquinolones, according to research from the Journal of Clinical Microbiology. Treatment with antimicrobials significantly increases the risk of developing a C. difficile infection.
4. COVID-19 and Candida auris are the newest threats to watch
Aside from hospital-acquired SARS-CoV-2 infections, the pandemic has revealed several key developments that should be accounted for while planning for the future of infection control. Contact tracing for healthcare personnel with occupationally acquired COVID-19 is key for maintaining clinician safety and avoiding transmission to patients.
But COVID-19 isn’t the only relatively new risk. While tracking has been complicated by the pandemic, the CDC reports Candida auris is an increasing source of infections, especially from patients who have received care in other locations (domestic or international) that have higher C. auris transmission. This threat highlights the need to track and understand the direct impact community transmission has on your facility. Mortality rates can be significant: based on information from a limited number of patients, 30–60% of people with C. auris infections have died.
Infection control programs should be prepared to address surge capacity during COVID-19 and other outbreaks, as well as understand the impact of outbreak response on your existing HAI prevention and infection control processes, procedures, and outcomes.
5. HAIs happen outside hospitals
Successful infection control plans consider the risks of HAIs beyond the boundaries of the hospital. As the US population ages, more surgical procedures happen in outpatient settings, and antimicrobial resistance increases, infection control leaders should examine HAIs in three key areas:
- Long-term care: The Pennsylvania Patient Safety Reporting System found a national infection rate of 1.07 infections per 1,000 resident days, with respiratory tract infections increasing between 2019 and 2020.
- Outpatient surgery: Ambulatory surgery centers and outpatient settings frequently don’t have the luxury of dedicated infection control personnel, making oversight and prevention increasingly challenging.
- Dialysis: Both patients and workers in hemodialysis settings are subject to increased risk of HAIs due to recurrent and prolonged blood exposure, proximity to other patients, and frequent hospitalization and surgery.
These challenges translate to a future of increased and specialized infection control and a need to rethink resources, research, and personnel dedicated to IPC efforts.
Stepping into a future of effective IPC
Despite the cracks revealed by COVID-19, the future of hospital-acquired infection control and prevention is hopeful. By supporting and investing in resilient, sustainable, and high-performing IPC programs, infection control leaders can improve outcomes and decrease infection-related variability that hampers quality of care. This goal will require a focus on staff education, efficiency, and technology like electronic surveillance systems that align with your goals.