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'Progress made but must try harder' say reports released today on HAI prevention
On any given day, approximately one in 25 US patients has at least one infection contracted during the course of their hospital care, adding up to about 722,000 infections in 2011, according to new data from the Centers for Disease Control and Prevention. This information is an update to previous CDC estimates of healthcare-associated infections.
The agency released two reports today - one, a New England Journal of Medicine article detailing 2011 national HAI estimates from a survey of hospitals in 10 states, and the other a 2012 annual report on national and state-specific progress toward US Health & Human Services HAI prevention goals. Together, the reports show that progress has been made in the effort to eliminate infections that commonly threaten hospital patients, but more work is needed to improve patient safety.
"Although there has been some progress, today and everyday, more than 200 Americans with healthcare-associated infections will die during their hospital stay," says CDC Director Tom Frieden, M.D., M.P.H. "The most advanced medical care won't work if clinicians don't prevent infections through basic things such as regular hand hygiene. Healthcare workers want the best for their patients; following standard infection control practices every time will help ensure their patients' safety."
The CDC Multistate Point-Prevalence Survey of Health Care-Associated Infections, published in NEJM, used 2011 data from 183 US hospitals to estimate the burden of a wide range of infections in hospital patients. That year, about 721,800 infections occurred in 648,000 hospital patients. About 75,000 patients with HAI's died during their hospitalisations. The most common HAI's were pneumonia (22%), surgical site infections (22%), gastrointestinal infections (17%), urinary tract infections (13%), and bloodstream infections (10%).
The most common germs causing HAI's were C. difficile (12%), Staphylococcus aureus, including MRSA (11%), Klebsiella (10 %), E. coli (9%), Enterococcus (9%), and Pseudomonas (7%). Klebsiella and E. coli are members of the Enterobacteriaceae bacteria family, which has become increasingly resistant to last-resort antibiotics known as carbapenems.
The second report, CDC's National and State Healthcare-associated Infection Progress Report, includes a subset of infection types that are commonly required to be reported to CDC. On the national level, the report found a:
- 44% decrease in central line-associated bloodstream infections between 2008 and 2012
- 20% decrease in infections related to the 10 surgical procedures tracked in the report between 2008 and 2012
- 4% decrease in hospital-onset MRSA between 2011 and 2012
- 2% decrease in hospital-onset C. difficile infections between 2011 and 2012
"Our nation is making progress in preventing healthcare-associated infections through three main mechanisms: financial incentives to improve quality, performance measures and public reporting to improve transparency, and the spreading and scaling of effective interventions," reports Patrick Conway, M.D., Deputy Administrator for Innovation and Quality for Centers for Medicare & Medicaid Services (CMS) and CMS chief medical officer. "This progress represents thousands of lives saved, prevented patient harm, and the associated reduction in costs across our nation."
The federal government considers elimination of HAI's a top priority and has a number of ongoing efforts to protect patients and improve healthcare quality. In addition to CDC's expertise and leadership in publishing evidence-based infection prevention guidelines, housing the nation's HAI laboratories, responding to healthcare facility outbreaks and tracking infections in these facilities, other federal and non-federal partners are actively working to accelerate the prevention progress that is happening across the country. These initiatives are coordinated through the National Action Plan to Prevent Healthcare-Associated Infections and include CMS' Partnership for Patients, CMS Quality Improvement Organisations, and the Agency for Healthcare Research and Quality's Comprehensive Unit-based Safety Programme.
The Progress Report looked at data submitted to CDC's National Healthcare Safety Network (NHSN), the nation's HAI tracking system, which is used by more than 12,600 healthcare facilities across all 50 states, Washington, D.C., and Puerto Rico. Not all states reported or had enough data to calculate valid infection information on every infection in this report. The number of infections reported was compared to a national baseline.
In the report, none of the 50 states, Washington, D.C., or Puerto Rico performed better than the nation on all four infection types tracked by state (CLABSI, CAUTI, and infections after colon surgery and abdominal hysterectomy). Some 16 states performed better than the nation on two infections, including two states performing better on three infections. In addition, 16 states performed worse than the nation on two infections, with seven states performing worse on at least three infections.
Expanding upon current patient safety goals, the FY 2015 President's Budget requests funding for CDC to increase the detection of antibiotic resistant infections and improve efforts to protect patients from infections, including those detailed in today's CDC reports. Additionally the President's Budget requests an increase for the National Healthcare Safety Network to fully implement tracking of antibiotic use and antibiotic resistance threats in US hospitals.
To access both reports and to see the updated HAI data, see CDC's website: www.cdc.gov
27th March 2014