HAIs on the down­swing

Progress made, but new strate­gies may be needed

Modern Healthcare - - COVER STORY - Jaimy Lee

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.

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