It’s Not Easy Being Clean

Photo courtesy of Flickr Creative Commons user Moria

Some of the rules seem simple. To prevent health care–associated (formerly called “nosocomial”) infections, hospital staff should wash their hands, use gloves and gowns, and disinfect the patients’ physical environment. But as I learned last week in Atlanta at the Fifth Decennial International Conference on Healthcare-Associated Infections, it takes far more than that.

About 1 in 20 patients in U.S. hospitals develop a health care–associated infection (HAI), leading to 99,000 deaths at a cost of up to $33 billion annually, numbers that Dr. Thomas R. Frieden, chief of the Centers for Disease Control and Prevention, deemed “unacceptable” in his opening remarks at the conference.

Dr. Frieden outlined the U.S. Health and Human Services’ Action Plan, launched in June 2009, which establishes measurable national goals for reducing HAIs. Five-year targets range from 25% reductions in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and surgical site infections to 50% reduction in all bloodstream infections to 100% adherence to central-line insertion practices.

“What is acceptable? Changing the norm so HAIs are viewed as preventable events,” he said.

The trick is finding exactly what works and successfully implementing those measures. A big debate in the field is whether universal MRSA screening and surveillance of hospital patients is necessary to prevent that organism’s spread. The practice is common in Europe and has been mandated in at least one U.S. state, Illinois.

However, in a study conducted at Virginia Commonwealth University, Richmond, “conventional” infection control measures including hand hygiene, chlorhexidine bathing of ICU patients, and use of central line and “ventilator bundles” resulted in significant reductions in device-related MRSA rates without the need for screening. But other studies suggest universal screening may be necessary to meet infection control targets.

Meantime, as many efforts to reduce MRSA have been successful over the last decade, a study of 28 community hospitals in the Southeastern United States found that Clostridium difficile has now surpassed MRSA in prevalence.

Another seemingly simple infection control measure—vaccinating all hospital employees against influenza—evidently requires a mandate to actually happen. Two studies presented at the conference—one from Nashville-based Hospital Corporation of America, the other from Children’s Mercy Hospital of Kansas City—found that nearly 100% compliance could be achieved only after requiring employees to receive flu vaccine with very limited opportunity for exemption.

I asked renowned infectious disease expert Dr. William Schaffner of Vanderbilt University, Nashville, Tenn., whether he believes that HAIs can ever be reduced to zero. Realistically, he said, they will never be completely eliminated because patients today are more frail and immunocompromised and because current treatments are “more elaborate, invasive, and compromising of the immune system.”

But, he does believe HAIs can be dramatically reduced: “The adoption of checklists and many of the research findings presented at the Decennial meeting will enable us to cut the frequency of [HAIs] at least in half over the next decade. In addition, we will collaborate with our partners around the globe to extend those benefits worldwide.”

–Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Allergy and Immunology, Emergency Medicine, Family Medicine, Gastroenterology, Health Policy, Hospice and Palliative Care, Hospital and Critical Care Medicine, IMNG, Infectious Diseases, Internal Medicine, Oncology, Orthopedic Surgery, Pediatrics, Surgery, Thoracic Surgery, Transplant Medicine and Surgery, Urology

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