Healthcare-associated infections (HAI) are those infections acquired by a patient when receiving treatment in a healthcare setting like a hospital, nursing home, or outpatient facility. Although these HAI's have been around for nearly two centuries, they are becoming increasingly more prevalent and difficult to treat. As a result, state governments and the CDC have begun implementing policy changes and programs designed specifically to address this growing issue. Significant progress has been made toward reducing the occurrence of these infections, but much more can be done and ensuring sustainability of these programs is important. In the later part of this blog, several tables are included that show the progress that has been made in this area, and also information on the specific programs that our state of Colorado has implemented. With all this progress, the initial statistics are still startling:
· HAI’s cost in excess of $33 billion in additional medical treatment.
For further details on the Direct Medical Cost of HAI’s visit:
http://stacks.cdc.gov/view/cdc/11550/
· In 2011, only 28 states had required reporting provisions in place for HAI’s.
· Inspections by the Centers for Medicaid and Medicare Services identified that 2/3 of ambulatory surgical centers had infection control lapses.
· In 2002, there were 99,000 reported deaths among both adults and children from HAI’s.
Summary video on HAI’s
http://www.youtube.com/watch?v=WdF58yUXNh8
The CDC has taken a leading role in the prevention and implementation of programs aimed at reducing the incidence of HAI's. In addition, state and local governments continue to support these efforts on a smaller scale, but no less effectively. The following is information regarding the CDC and their specific targets for HAI's.
CDC 2015 Targets for Hospital-associated infections (HAI) prevention
The CDC would like to ensure safe healthcare for all Americans by reducing the number of healthcare-associated infections (HAI). They plan to achieve this by promoting and tracking the use of proven HAI prevention practices and increasing the use of the National Healthcare Safety Network (NHSN) surveillance system.
The 2015 Targets set by the CDC include:
1. A 60% reduction in central line-associated blood stream infections (CLABSI) compared to 2006-2008 baseline values.
2. A 60% reduction in Methilicillin-Resistant Staphylococcus Aureus (MRSA) infections compared to 2007-2008 baseline values.
3. A 30% reduction in surgical site infections (SSI) compared to 2006-2008 baseline values.
4. A 30 % reduction in catheter-associated urinary tract infections (CAUTI) compared to 2009 baseline values.
Data from 2011 shows sufficient progress is being made towards the 2015 goals. Data collected between 2009 and 2011 and graphed below show a 40% reduction in CLABSI, a 20% reduction in MRSA, a 20% reduction in SSI, and a 10% reduction in CAUTI infections.
The Healthy People 2020 project also has weighed in on the subject of HAI's, and they have similar objectives and goals to those identified by the CDC. A comparison and contrast of these goals follows:
Healthy People 2020 and the CDC 2015 Goals
In comparison, the Healthy People 2020 Goals and Objectives are similar to the CDC’s 2015 Goals for CLABSI and MRSA. No goals and objectives were set for SSI and CAUTI. The Healthy People 2020 Goals specify a reduction in CLABSIs by 75% from 2006-2008 baseline values and reduction in MRSA infections by 75% from 2007-2008 baseline values. The longer time frame allotted allows for a larger reduction to be observed. Data from 2010 showed progress is being made towards the 2020 goals with a 32% reduction in CLABSI and a 19.6% reduction in MRSA. These trends are equivalent to the CDC 2011 trends graphed above.
On a national and state level, multiple interventions have been identified that are successful in reducing the amount of HAI's. Some studies have noted that reductions of 70% or more have been achieved, but more importantly, are sustained over time. Five main interventions and their associated statistics are noted below:
Interventions
A number of interventions in the forms of campaigns, action plans, new policies and guidelines have been developed to address either specific or multiple risk factors for HAIs. Brief descriptions of some of the inventions currently in place to prevent HAIs are outlined here.
1. Hand Hygiene Campaign
Hand Hygiene when performed correctly is the most effective way to prevent transmission of pathogens that cause HAIs. The CDC is committed to improving hand hygiene in the healthcare setting by promoting education, training, and adherence by healthcare workers. The World Health Organization (WHO) has developed a standardized form for measuring hand hygiene adherence. The WHO’s “ 5 moments for hand hygiene” include performing proper hand hygiene before touching a patient, before a clean or aseptic procedure, after body fluid exposure, after touching a patient, and after touching patient surroundings. To read more on the CDC and WHO guidelines and promotional campaigns on hand hygiene in healthcare go to http://www.cdc.gov/handhygiene.
2. Get smart About Antibiotics Campaign
The overuse of antibiotics contributes to the growing challenges posed by antibiotic resistant bacteria such as Clostridium difficile. Therefore, improving the use of antibiotics will reduce the rates of Clostridium difficile HAI infections, and save hundreds of thousands of dollars in healthcare costs. Get Smart for Healthcare is a CDC campaign focused on improving antibiotic use in healthcare facilities. As part of this campaign, the CDC along with the 25 of the nation’s leading healthcare organizations created a joint policy statement focused on preserving antibiotic effectiveness and combating resistance. In this joint statement, the organizations involved committed to both conserve and replenish the antibiotic resources through a number of principles including improving antibiotic use. To read more about this campaign go to http://www.cdc.gov/getsmart/healthcare.
3. Safe Injection Practices Campaign
Unsafe injection practices put patients and healthcare providers at risk of infections. The CDC and the Safe Injection Practices Coalition’s One& Only Campaign promotes safe injection practices among patients and healthcare providers with the emphasis on One Needle, One Syringe, Only One Time for each injection. The goal is to ensure patients are protected each and every time they receive an injection. To read more on this campaign go to http://www.oneandonlycampaign.org.
4. Guidelines for the Prevention of Intervascular Catheter-Related Infections
In 2011, the CDC proposed new guidelines aimed at reducing the number of catheter-related infections (CRBSI). The 5 major areas of emphasis include: training and education of healthcare personnel, use of maximal sterile barrier precautions during insertion, use of >0.5% chlorhexidine skin preparation with alcohol for antisepsis, avoiding routine replacement of catheters, and the use of antiseptic/antibiotic impregnated catheters. To read more on these guidelines go to http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.
5. National Action Plan to Prevent Healthcare-Associated infections: Roadmap to elimination
In 2009 the U.S. Department of Health and Human Services released an initiative aimed at HAI prevention entitled the HHS Action Plan to Prevent Healthcare–Associated Infections (HAI). The plan focuses on HAI prevention in hospitals and outpatient environment s as well as the role of healthcare professionals in ensuring optimal patient outcomes. This action plan outlines multiple strategies to address the prevention of all HAIs in every setting and every facility for every patient. To accomplish this, strategies set forth in this plan include actions taken by not only the frontline clinicians but also clinical leaders, executives and administrators, government, and advocates. The 10 key strategies for preventing HAIs in this plan include: reducing inappropriate/unnecessary device use, improving adherence to hand hygiene and barrier precautions, implementing and improving antimicrobial use, demonstrating leadership support, implementing a culture of safety, enhancing financial incentives and regulatory oversight, implementing system-based protocols/checklists, better use of technology, improving public reporting of credible data, and enhancing traditional and non-traditional partnerships. To read more on this initiative go to www.hhs.gov/ash/initiatives/hai
In conclusion, several plans to reduce the amount of healthcare-associated infections have been listed previously in this blog post, but we feel as a group that hand washing is the easiest method of meeting this goal. Proper hand hygiene is an inexpensive, effective way of preventing infection in all healthcare settings. By ensuring that this practice is standardized, enforced, and practiced by every individual in healthcare, not only will a great deal of money be saved and available for other worthy needs, but lives will be spared as well. Big players in public health like WHO and CDC have already made this objective a priority and have taken initiatives to guarantee that HAI’s will be reduced globally. As a group, we feel that local healthcare facilities can meet this goal by consistent, appropriate training of staff regarding hand cleanliness and sanitation. Adopting such a simple behavior can improve the public’s health tremendously.
CDC video (addressing why resolving HAI is important)
References
Association of State and Territorial Health Officials. (2011). Eliminating Healthcare-associated Infections: State Policy Options. Retrieved from http://www.astho.org/Programs/Infectious-Disease/Healthcare-Associated-Infections/State-Policy-Options-Toolkit/.
CDC (n.d.). Citing Websites. In Winnable Battles: Healthcare Associated Infections (HAI). Retrieved May 4, 2013 from http://www.cdc.gov/WinnableBattles/targets/HAI/.
CDC Streaming Health. (2013). Director’s Briefing: Healthcare-associated Infections. Retrieved from http://www.youtube.com/watch?v=lm9aHhPVoyY.
Colorado Department of Public Health and Environment. (2013). Healthcare-associated Infections Guidelines and Resources. Retrieved from http://www.colorado.gov/cs/Satellite?c=Page&childpagename=CDPHE-HF%2FCBONLayout&cid=1251616590013&pagename=CBONWrapper.
Dixon, R.E. (2011). Control of Healthcare-associated Infections. CDC: Morbidity and Mortality Weekly Report. 60(4), 58-63.
Edmundson, L. (2013). Drop in Healthcare-associated Infections is Good News for U.S. Patients. Retrieved from http://www.healthmap.org/news/drop-healthcare-associated-infections-good-news-us-patients-21513.
Ellingson, Kate (2010). Citing Podcast Website. In “COCA Call: New Frontiers in Hand Hygiene Practices”. Retrieved May 4, 2013, from http://www2c.cdc.gov/podcasts/player.asp?f=1626091.
GE Healthcare. (2013). Qualibria Clinical Knowledge Solution. Retrieved from http://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Clinical_Knowledge_Solutions/Qualibria#tabs/tabF9276BFC974146C9B6A923D397C92E5B.
Healthy People(n.d.). Citing Websites. In HealthCare-Associated Infections: 2020Objectives. Retrieved May 4, 2013, from http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=17.
Hygienic Solutions US. (2012). Healthcare Associated Infections HAI – Control Hospital Infection. Retrieved from http://hs-us.com/healthcare-associated-infections-hai-control-hospital-infection/.
Jayan, N. Dr. (2011). Developing Nations Threatened by Healthcare-associated Infections. Retrieved from http://www.medindia.net/news/healthwatch/Developing-Nations-Threatened-by-Healthcare-Associated-Infections-79418-1.htm.
Klevens, R.M., DDS, MPH, Edwards, J.R., MS, Richards, C.L. Jr., MD, MPH, Horan, T.C., MPH, Gaynes, R.P., MD, Pollock, D.A., MD, Cardo, D.M., MD. (2007). Estimating Health Care-Associated Infections and Deaths in US Hospitals, 2002. Public Health Report. 122(2), 160-166.
Mazzulo, Y.P. (2012). Healthcare Associated infections Report Shows Decline. Retrieved from http://www.examiner.com/article/healthcare-associated-infections-report-shows-decline.
Nucleus Medical Media. (2012). Preventing Healthcare Associated Infections. Retrieved from http://www.youtube.com/watch?v=WdF58yUXNh8.
O’Grady, Naomi et.al. (2011). Citing Website. In Guidelines for the Prevention of Intervascular Catheter-Related Infections, 2011. Retrieved May 4, 2013, from http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.
The Center for Disease Dynamics, Economicss, and Policy (2012). Citing Websites. In Joint Statement on Antibiotic resistance with the U.S. Centers for Disease Control and Prevention (CDC) and 25 National Health Organizations. Retrieved May 4, 2013, from http://www.cddep.org/publications/joint_statement_antibiotic_resistance_us_centers_disease_control_and_prevention_cdc_and.
US Department of Health and Human Services (2009). Citing Websites. In National Action Plan to Prevent Healthcare-Associated infections: Roadmap to elimination. Retrieved May 4, 2013 from
http://www.hhs.gov/ash/initiatives/hai/infection.html.
World Health Organization (2009). Citing Websites. IN WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care is Safe Care. Retrieved May 4, 2013, from http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf.
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