Progress Report on Healthcare-associated Infections

Healthcare-associated infections (HAIs)—those infections that patients contract while receiving treatment for medical or surgical conditions—are the most common complication of hospital care and a major threat to patient safety. They drive up health care costs and are among the leading causes of preventable deaths in the U.S. The good news is that they are preventable.

The U.S. Department of Health and Human Services is committed to reducing the incidence of HAIs and has established objectives that focus primarily on central line-associated bloodstream infections (CLABSIs) and methicillin-resistant Staphylococcus aureus (MRSA) infections. Together with CLABSIs and MRSA infections, catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and pneumonia round out the list of major contributors to HAIs in acute care settings.

Circumstances that create opportunities for HAIs include post-surgical complications, transmission between patients and health care workers, and the use and maintenance of medical devices, such as catheters and ventilators. An insufficient nurse-to-patient ratio, contaminated air conditioning systems, and even the physical layout of the health care facility—for example, when patient beds are placed too close together—can also contribute.

Keeping Infections at Bay
Recent research suggests that HAIs can be reduced by as much as 70 percent, saving an estimated $25 billion to $31.5 billion in medical costs when existing prevention practices are properly implemented. Educating health care workers on infection control increases compliance with these practices.

According to the Centers for Disease Control (CDC), one in 25 hospital patients has at least one HAI. In 2011 alone, the CDC estimated that 722,000 patients were infected with some type of HAI. Of these infected patients, about 75,000 died during hospitalization. More than half of all HAIs occurred outside of the intensive care unit.

The CDC publishes a progress report that contains details about the status of efforts to eliminate HAIs. The report shows that the infection rate for CLABSIs and SSIs has been significantly reduced. There’s also been some progress in reducing hospital-onset MRSA and hospital-onset C. difficile infections. CAUTIs, however, are on the rise.

Specific findings in the CDC’s progress report include:

  • a 46% decrease in CLABSIs between 2008 and 2013
  • a 19% decrease in SSIs related to the 10 select procedures tracked in the report between 2008 and 2013
  • an 8% decrease in hospital-onset MRSA bacteremia between 2011 and 2013
  • a 10% decrease in hospital-onset C. difficile infections between 2011 and 2013
  • a 6% increase in CAUTIs between 2009 and 2013.

Along with other initiatives, the Affordable Care Act and health care payment reforms have brought into sharp focus the need to prevent infections and other adverse events because of their direct impact on patient safety and health care costs. Care providers must take steps to reduce infection rates and protect their patients. The CDC offers a comprehensive list of guidelines for preventing HAIs.
FierceHealthcare, a source for health care industry news, also offers these recommendations:

  • Educate care providers and patients about hand hygiene. Health care facilities should let patients know that they should expect care providers to perform proper hand hygiene and that it’s acceptable for patients to ask if their care providers have washed their hands before examining them. Care providers need to be well educated not only in infection prevention techniques but also about risk factors, diagnosis, and treatment. Hospitals in California that participated in the Patient Safety First Initiative (an initiative to improve quality of care, reduce health care costs, and save lives by improving patient safety) benefited from peer-to-peer learning and were able to reduce ventilator-associated pneumonia (VAP) by 57%, CAUTIs by 24%, and sepsis mortality rates from 22.58% to 16.62% between 2009 and 2012, according to a report from the National Health Foundation.
  • Minimize red blood cell transfusions. Research has shown that infection rates drop by as much as 20% when red blood cell transfusions are restricted. In one study, the rates of pneumonia, mediastinitis, wound infections, and sepsis were lower in clinical trials where red blood cell transfusions were kept to a minimum.
  • Work as a team to combat infections. Teamwork—from the executive suite to frontline care providers—can have a significant impact on infection rates. For example, when a disinfecting team at Louis Stokes Cleveland Veterans Affairs Medical Center was dedicated to cleaning high-touch surfaces, C. difficile room infection rates dropped by 89 percent.
  • Replace surfaces with copper. Studies suggest that copper surfaces on bed rails, tables, IV poles, and nurse call buttons can reduce infection rates by 60%. The copper’s electrical conductivity renders microbes inactive.
  • Take advantage of technology. Portable machines that use ultraviolet light to kill bacteria and viruses are in use at more than 100 hospitals. These machines, which can be rolled into rooms to supplement regular cleaning, have helped to reduce C. difficile by almost 70 percent at Cooley Dickinson Hospital in Massachusetts and MRSA by 35 percent at four North Carolina hospitals. Facilities can also use biosensors to combat super bugs. These sensors detect antibiotic resistance in bacteria and can be used to disinfect rooms as well as kill bacteria on care providers so that harmful bacteria won’t be transmitted to patients.

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