BETHESDA, MD 13 February 2009—Experts from across the U.S. Department of Health and Human Services (HHS) have produced an action plan to create a national road map for reducing the number of health-care-associated infections.
The HHS Action Plan to Prevent Healthcare-Associated Infections is a proposal that includes plans to create five-year national targets, expand research efforts on infection prevention, and find more ways to encourage hospitals to implement proven infection-reduction techniques.
“Healthcare-associated infections are one of the most preventable causes of leading mortality in the U.S.,” wrote the authors of the plan. “The infections also add a significant economic burden to the healthcare system.”
Health-care-associated infections are among the leading causes of mortality in the United States, with 99,000 deaths and 1.7 million infections in 2002, according to the plan’s authors. These infections are believed to cost the health care industry $20 billion a year.
HHS officials focused on surgical-site infections, central-line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. These issues are thought to account for about 75% of health-care-associated infections, according to the plan’s authors.
Urinary tract infections account for roughly 32% of health-care-associated infections, followed by surgical-site infections at 22%, pneumonia at 15%, and bloodstream infections at 14% in 2002, according to a 2007 article titled Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002, published in Public Health Reports. The plan also examines infections linked to Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA).
The draft action plan is another way to encourage hospitals to pay closer attention to the problem, said Richard Drew, an infectious diseases pharmacist at DukeMedicalCenter in Durham, North Carolina. While it is an important issue for patient safety, the added burden of financial penalties from payers may cause more hospitals to take action to prevent these problems.
“Once administrators understand that payment and reimbursement are affected by this, a lot of people will pay more attention to it,” said Drew, who is also a professor at the Campbell University School of Pharmacy, in Buies Creek, North Carolina. He said DukeMedicalCenter has a number of active programs aimed at reducing health-care-associated infections.
A major goal of the HHS plan will be to prioritize the 1200 recommended clinical practices. HHS experts would push for hospitals to adopt the most effective of these practices.
The plan also acknowledges the need for more research to understand the full extent of the problem. A number of government programs measure statistics related to health-care-associated infections, but due to varying definitions and collection methods, the data are often not directly comparable. HHS is looking for ways to make data collection more unified.
Drew noted that the plan calls for improved surveillance systems so hospitals can more quickly recognize and document newly developed infections.
Robert Rapp, a professor at the University of Kentucky College of Pharmacy, in Lexington, said much of the plan covers the same goals and topics discussed in previous documents from various health care organizations and government agencies.
The new HHS planning document nearly omits all information on six of the leading pathogens that infectious disease experts are worried about, Rapp explained. Enterococcus faecium, Klebsiella species, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species were not mentioned in the HHS report, though MRSA is noted.
“At least that would allow hospitals to focus on the six that most of the experts believe are the worst of the resistance pathogens that we have,” he said of listing the pathogens. “I think that’s a tremendous omission in the document,” he said.
Most of these organisms are resistant to almost every antibiotic available, he said. With no new antibiotics on the horizon in the next 15–20 years, there is a need to provide incentives for the pharmaceutical industry to develop these next-generation drugs.
“There is absolutely no mention of the pharmaceutical industry and the need for them to develop new antimicrobials,” said Rapp, an infectious diseases expert. “How can they not mention this?”
While there may be no mention of the need for new drugs, the plan does call for informing health care providers of the best practices to prevent these infections.
“From a pharmacist’s perspective, there is stuff in there that offers us another set of opportunities,” Drew said.
Pharmacists can collaborate with other health care professionals in hospitals on antimicrobial stewardship and developing guidelines on issues such as properly inserting catheters.
Among the stated research goals of the HHS document are determining the preventability of unnecessary antibiotic use and C. difficile infections.
The document’s authors also want to know about any potential cultural or organizational barriers that may prevent the implementation of best practices to stop health-care-associated infections.
On the incentive side, the document’s authors want to continue finding performance-based payment options for hospitals, possibly by encouraging facilities to measure and report infection-prevention rates and outcomes. The report also includes details on seeking wider adoption of electronic reporting from facilities to improve the timing, efficiency, and reliability of data related to health-care-associated infections.
“It’s a boon for infection control, and I think it’s an opportunity for pharmacists,” Drew said of the HHS document.
