By Kelly M. Pyrek
More than 3,200 professionals in the fields of infection prevention and control, public health, occupational health, quality improvement and others convened in mid-March to set the agenda for the next 10 years of research and discourse pertaining to healthcare-acquired infections (HAIs). The Fifth Decennial International Conference on HAIs, co-organized by the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiologists of America (SHEA), the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC), represents the first time that four leading scientific organizations committed to infection prevention are working together to further a scientific and educational agenda toward elimination of HAIs.
“Healthcare-associated infections can have tragic outcomes,” says Thomas Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC). “This meeting brings together experts from around the world to share the latest strategies in infection prevention, bringing us closer to our goal of eliminating healthcare-associated infections.”
In the opening plenary session, Frieden delivered an inspired presentation on "The U.S. Approach to Maximize Infection Prevention in the Next Decade" with an emphasis on "defining the unacceptable." What this entails, according to Frieden, is the number of people who are sickened or die from hospital-acquired infections, how little we know about the burden of infections, how rare the implementation of prevention measures is, and the fact that we don't know how many infections are preventable. “Defining unacceptable is ending the old ways of doing things,” Frieden said.
The toll of HAIs is staggering – as many as 1 in 20 patients is affected by an HAI, triggering up to $33 billion in excess medical costs annually. Frieden said the challenge for this new decade is to better understand transmission factors, but the effort is confounded by the lack of compliance with evidence-based practices; he reports that just 30 percent to 38 percent of hospitals are in full compliance with key infection prevention and control guidelines, and just 40 percent of hospitals adhere to hand hygiene practices. Frieden said that the norm in U.S. hospitals must be changed, so that HAIs are seen as being preventable and that improved guideline adherence is critical for curbing infections. He added that this would require additional funding and resources, as well as improved surveillance, better research, additional prevention tools and the engagement of stakeholders and the media – all of which are components of the Department of Health and Human Services’ Action Plan to Prevent Healthcare-Associated Infections.
Frieden says the action plan boils down to taking three concrete steps to reducing HAIs: improving surveillance, taking practical action (including creating an organizational culture of safety and following evidence-based guidelines) and addressing knowledge gaps, which also includes an implementation gap. Frieden encouraged the continued development of partnerships between state and local health departments, healthcare institutions, healthcare consumers, members of industry, global and national health partners and professional organizations.
These efforts are nothing, however, without a focused research agenda, says the CDC’s John Jernigan, MD, who moderated a plenary session on “Setting the Research Agenda for the Next Decade.” As Jernigan observed, “Great strides have been made due to better use and implementation of what we already know, but we need to aggressively pursue what we don’t know.”
Panelist David Henderson, MD of the National Institutes of Health, noted that there is a problem with the science base that supports infection prevention and control. He explained that it is inadequate to provide definitive support for the HAI-reduction recommendations that are made. “Implementation science has reduced risk but it is not the complete answer,” Henderson said. “The existing guidelines have a one-size-fits-all approach that won’t work in diverse healthcare settings.” For example, Henderson pointed to the concept of bundles; while they appear to be effective, Henderson said some aspects of the interventions are better known than others and this knowledge gap is of concern. At the heart of translational research is translating an idea from research into practice, going from the concept to the proof of the principle and then moving principle into practice in the real-world setting of healthcare. Henderson pointed to the current knowledge gaps, which included pathogenesis and the mechanisms of acquisition; epidemiology (including the role of the environment, optimal sites for culturing, settings in which screening is beneficial); the efficacy of prevention interventions such as hand hygiene, isolation, bundles, decolonization); study design; and technology (such as rapid diagnostics).
