HEALTH CARE ASSOCIATED-INFECTIONS LINKS

New Tool in the Fight Against Health Care–Associated Infections: Compendium of Strategies to Prevent Healthcare–Associated Infections in Acute Care Hospitals

The Centers for Disease Control and Prevention estimates there are approximately 1.7 million new cases of infections that are acquired by patients during their stay in hospitals every year. Of these, approximately 99,000 result in death (although there may be other factors besides infection), making health care–associated infections (HAIs) one of the top ten causes of death in the United States. From a business perspective, this translates into a cost of approximately $4.5–$6.5 billion a year for hospitals to combat these infections.

Over the years, health care organizations and government offices have developed numerous strategies and guidelines to battle HAIs. However, there have been many obstacles in the systematic implementation and use of these strategies. Chief among these is a lack of compliance with proven guidelines for reducing the incidence of HAIs. For example, studies have found that hand washing—the most basic, low cost, and low technology infection prevention strategy—is ignored by half of hospital workers. More dramatically, a survey by The Leapfrog Group has demonstrated that 87% of hospitals did not consistently follow infection-control guidelines. As Dr. Patrick J. Brennan, Chairman of the CDC’s Healthcare Infection Control and Prevention Advisory Committee (HICPAC) states, “Too often where we fail is not in the knowledge but in the execution”.

Now, hospitals and other health care organizations have a new weapon in their fight against HAIs. On Wednesday, October 8, 2008 the Compendium of Strategies to Prevent Healthcare–Associated Infections in Acute Care Hospitals was unveiled. This document, sponsored by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) in collaboration with the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA) and The Joint Commission, represents a compendium of practice recommendations aimed at eradicating six of the most common HAIs. The Compendium addresses the following HAIs:

1.    Central Line–Associated Bloodstream Infections (CLABSI) arise when bacteria, most commonly Staphylococcus aureus and
       Staphylococcus epidermidis sepsis, enter the lines that are used for delivering fluids to patients and travel to the bloodstream.
2.    Ventilator-Associated Pneumonia (VAP) occurs most often in patients who use ventilators to assist with their breathing for at least 
        48 hours. Infections arise in endotracheal or tracheostomy tubes and affect the lung’s ability to absorb oxygen.
3.    Catheter-Associated Urinary Tract Infections (CAUTI) are infections of the bladder, kidneys, prostate, or urethra caused when
        bacteria travels through the catheter. The risk of developing CAUTI increases dramatically in patients who use catheters over long
        periods of time.
4.    Surgical Site Infections (SSI) are infections that arise in wounds in patients who have undergone surgery.
        Infections may develop in wounds that are open or closed and may affect tissues at all levels from superficial, to deep, all the way
        to the organ level.
5.    Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of Staphylococcus aureus that is resistant to a large group of
        antibiotics, including methicillin and penicillin, and which causes infections of the skin, blood, lungs, or open wounds.
6.    Clostridium difficile (CDF or C. diff) is an infection of the colon caused when the intestinal tract’s naturally
        occurring microorganisms are eliminated through the use of antibiotics and the C. difficile bacteria, which is usually found in 
        normal levels in the intestinal tract, grow out of control.

Although the Compendium is based on previous recommendations and current research, it represents an improvement over previous documents for several reasons. First, the authors state that the Compendium recommendations are written in a much clearer and more concise manner than previous guidelines; the information is not new, but the presentation of the information is unique. “In developing these strategies, we looked at all existing HAI guidelines and literature to create recommendations that are understandable, easy-to-use and stress accountability,” said David Classen, IDSA spokesperson and co-author of the Compendium. Second, the Compendium not only offers best practices for hospitals to follow in their fight against HAIs, but also provides hospitals with advice on which approaches not to pursue. In addition, though it represents a compilation of current research and evidence-based recommendations, it is distinguished from previous guidelines by presenting practical recommendations using an implementation-focused format. As the Compendium’s lead author and SHEA spokesperson, Dr. Deborah S. Yoke, states, “Healthcare providers’ goal is to offer the best and safest patient care possible. Not all HAIs are preventable, but it is imperative that we implement practices that we know are effective to prevent as many of these infections as possible.” Lastly, the Compendium takes a two-tiered approach by recommending special approaches when first-line basic strategies are not successful in lowering infection rates. These improvements led Dr. Richard J. Umbdenstock, President of the American Hospital Association, to state, “As of today, the nation’s infection control team has a common playbook.”

According to Dr. Robert A. Wise, Vice President, Division of Standards and Survey Methods at The Joint Commission, “The Compendium meets a great need for clear, user-friendly language, and was an important component in the development of The Joint Commission’s 2009 National Patient Safety Goals on HAIs.”  In addition, The Joint Commission will devote time to incorporating the guidelines presented in the Compendium into its accreditation standards in 2010.