HAIs on the downswing
Progress made, but new strategies may be needed
Prodded by federal and state regulations, hospitals have made significant strides to combat hospital-acquired infections. Even so, some say more work needs to be done to address infections that occur outside the intensive-care unit and that hospitals should consider new strategies for better results.
The Centers for Disease Control and Prevention reported a 41% reduction in central line-associated bloodstream infections and a 17% reduction in surgical-site infections in 2011, when compared to infections reported in 2008. Life-threatening infections of methicillin-resistant Staphylococcus aureus fell by 48% from 2005 to 2010.
The deadline for another HHS program gathering data about infections is approaching. The goal of HHS’ National Action Plan to Prevent Health Care-Associated Infections, which aims to reduce infections during a three-year period beginning in 2010, is to demonstrate reductions in hospital-acquired central line-associated bloodstream infections and catheter-associated urinary tract infections. The deadline is Sept. 30.
“We’re in a pretty good place,” said Lisa McGiffert, director of Consumers Union’s Safe Patient Project. “The challenge now is expanding what’s going to be reported.”
Thirty states have laws requiring some level of public reporting on hospital-acquired infections. However, a recent bill in Washington state raised concerns with McGiffert’s group because it sought to cut back state reporting requirements for surgical infections for highvolume hip and knee replacements and heart procedures that would have aligned the state’s regulations with federal reporting rules.
That legislation was blocked. This month Washington Gov. Jay Inslee, a Democrat, signed into law a bill requiring public reports on a broad array of bloodstream infections occurring almost anywhere in a hospital, including those associated with cardiac, knee and hip operations. The Washington State Hospital Association and the state Department of Health
had wanted to exclude those three areas. “That was a big win for us,” McGiffert said. For hospitals, though, new studies show that traditional active detection and isolation programs may not be the most effective way to prevent and address infections in the ICU.
A study published last week in the New England Journal of Medicine found that using germ-killing soap and ointment on all ICU patients can reduce bloodstream infections by 44% and the presence of MRSA by 37%, making it a more successful strategy than routine care or providing germ-killing soap and ointment only to patients with MRSA.
The findings indicate that using soap and ointments on all ICU patients—a strategy known as universal decolonization—which involved no active detection or isolation, is more effective than targeted decolonization or screening and isolation. Most hospitals have adopted active detection and isolation programs.
“In conclusion, we found that universal decolonization prevented infection, obviated the need for surveillance testing, and reduced contact isolation,” the study’s authors wrote. “If this practice is widely implemented, vigilance for emerging resistance will be required.”
In a separate news release, CDC Director Dr. Thomas Frieden said the agency is working on how to use the study’s findings to inform its infection prevention recommendations.