The axiom, “the more things change, the more they stay the same,” easily could be applied to the practice of infection prevention and control, which, while experiencing a spike in the number of more sophisticated, evolving tasks infection preventionists now must perform, is still endeavoring to get back to basics. The most pressing issues for 2009 have a familiar ring to them, for the most part.
“In terms of themes that have remained the same for infection prevention and control, the cultural/behavioral change issue relating to compliance continues to be a huge uphill battle,” says Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology (APIC). “If we are going to protect patients, we need healthcare workers to commit 100 percent of the time to known infection prevention and control measures. For 2009, the impact of the new CMS regulations are front of mind right now, but the other big thing I think the APIC membership struggles with is getting ahead of multi-drug resistant organisms (MDROs), including the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile and emerging, potentially threatening organisms like Klebsiella. I think MDRO prevention is a primary concern.”
MDRO Prevention
The evidence is certainly pointing to the need for a renewed campaign against MDROs such as Clostridium difficile. In November, APIC released the results of its study, “National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities,” which indicated that 13 out of every 1,000 inpatients were either infected or colonized with C. difficile. Based on this rate, it is estimated that there are at least 7,178 inpatients on any given day in American healthcare institutions, with an associated cost of $17.6 to $51.5 million. The rate is 6.5 to 20 times greater than previous incidence estimates, according to the survey. The APIC survey, the largest, most comprehensive of its kind, presented a one-day snapshot in time of the prevalence of C. difficile infection (CDI) in American hospitals. APIC’s members collected data about all of their CDI patients on one day in between May and August 2008. Survey results were collected from 12.5 percent of all medical facilities in the U.S. and a total of 1,443 patients were identified with CDI from among the 648 participating hospitals.
“This study shows that C. difficile infection is an escalating issue in our nation’s healthcare facilities,” says William Jarvis, MD, principal investigator of the study and president and co-founder of Jason and Jarvis Associates, a private consulting firm in healthcare epidemiology. “Clearly, preventing the development and transmission of CDI should be a top priority for every healthcare institution.”
“Healthcare providers must intensify efforts toward consistent application of prevention strategies across the continuum of care,” says Warye. “Control of CDI requires adequate numbers of infection preventionists and environmental services personnel, and prevention practices need to be part of everyone’s job within the institution. As part of our Targeting Zero initiative, APIC will continue to call for the commitment of clinical and administrative leadership to providing adequate resources for infection prevention programs to better protect patients.”
