ICT asked clinicians for their thoughts on zero tolerance of infections:
“I think there are two issues with the focus on zero in the era of public reporting. The CDC’s healthcare-acquired infection definitions, particularly the BSI, classify many infections as CLABSI, when they are most likely not at all related to the central line. For example, gut organisms in the blood of the neutropenic patient are very unlikely to be caused by the line, but many such cases are misclassified as such by the definition, which lacks specificity. In addition, there will always be some infections which are truly not preventable. Some patients have risk factors which greatly increase their risk (e.g., morbid obesity), that there is not much we can do to modulate. So I continue to think that we have to push healthcare workers to be compliant with handwashing and good infection control techniques but we have to accept the fact that not all infections are avoidable.” -- Michael Edmond, MD, MPH, MPA, chair of the Division of Infectious Diseases and hospital epidemiologist at Virginia Commonwealth University Medical Center, Richmond, Va.
“I have been practicing as a certified infection preventionist for 21 years and I am not sure zero is a realistic target. But I think we could reduce infections by anywhere from 50 percent to 90 percent with everybody doing the right thing at the right time. Patients with underlying conditions that play a greater role than prevention methods, and cases where mechanical errors by the surgeon will be the biggest challenge in getting to zero. The former paradigm of two-thirds of healthcare-acquired infections cannot be prevented has been proven wrong. The attention and the dollars lost to infections have led to more resources for prevention. This is good news. Many of the recommendations to prevent infections are not new; CMS has many clinicians looking at them for the first time. We can greatly reduce infections through team efforts throughout healthcare. Can we get to zero? No one knows for sure but my experience tells me no.” -- Jan Johnson MS, CIC, Avera Sacred Heart Hospital, Yankton, S.D.
