Championing the Scientific Basis for Infection Prevention

As you are well aware, infection prevention and healthcare epidemiology have rarely had more of a spotlight than right now, with the convergence of healthcare reform, novel H1N1 influenza, broader awareness of bacterial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, and the increasing complexity of regulatory and reimbursement rules. The good news is that our scientific community has found its voice and we are offering our advice to law makers and administrators as they ponder these issues. Hopefully, our input will be valued and science and common sense will triumph.

In recent weeks, the Society for Healthcare Epidemiology of America (SHEA) has been busy representing our membership and has been vigorously advocating for the translation of knowledge into practice, adherence to evidence-based guidelines, enhanced investment in research, and adoption of standardized measurements and metrics – all leading to a broader base of knowledge and improved policies and practices to protect patients.

Examples of our efforts to assert science in healthcare policy follow:

Healthcare Reform: In mid-July the society partnered with the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC), the Council of State and Territorial Epidemiologists (CSTE) and the Trust for America’s Health (TFAH) to communicate support for provisions mandating national public reporting in the House tri-committee healthcare reform bill (America’s Affordable Healthcare Choices Act). The language in this bill calls for the Centers for Disease Control and Prevention (CDC) to establish reporting protocols through the National Healthcare Safety Network (NHSN). We believe this is the best method for ensuring the establishment of a scientifically meaningful healthcare-acquired infection (HAI) reporting system and it is largely consistent with SHEA’s long-standing position on the issue. In addition, support was voiced for greater attention to antimicrobial resistance. The letter to Chairman Henry Waxman can be found at http://www.shea-online.org/Assets/files/policy/Health_Care_Reform_-_HAIs_Joint_Letter_July_16_Final.pdf. The joint comments were limited to those provisions of the bill that dealt specifically with issues related to infection control and epidemiology and should not be misconstrued as broader support for the entire healthcare reform bill. Currently, Congress is in summer recess; however, debate regarding healthcare reform will be intense and ongoing and SHEA will remain engaged.

HHS Action Plan: SHEA has been in attendance at the Department of Health and Human Services (HHS) stakeholder meetings on the Action Plan to Prevent Healthcare-Associated Infections. The plan establishes a set of five-year national prevention targets and metrics to assess progress. SHEA commends HHS on the effort. We will continue to advocate for:

Elimination of preventable HAIs

HAI reporting with validated surveillance definitions and techniques through the CDC’s NHSN

HAI metrics that monitor evidence-based interventions

Substantial investment in a vigorous research agenda

Development and implementation of an educational curriculum. Readers interested in the SHEA talking points regarding the HHS action plan can review them at http://www.shea-online.org/Assets/files/policy/Talking_Points_National_Action_Plan_FINAL_072109.pdf

Novel H1N1 Influenza: In June, SHEA released a statement endorsed by IDSA and APIC advocating updates to CDC’s Interim Guidance on Infection Control Precautions for H1N1. The statement summarized current evidence and practical realities in implementation and addressed most specifically the issue of N-95 respirators for routine treatment of patients with novel H1N1 influenza. After an exhaustive review of current data, the Healthcare Infection Control Practices Advisory Committee (HICPAC) voted in favor of recommendations that are congruent with the SHEA/IDSA/APIC statement. SHEA will seek input into the Institute of Medicine ad hoc committee that has been recently formed to offer advice on this issue by Sept. 1. CDC will determine the final language by Oct. 1.

SHEA also published a joint statement on infection prevention precautions for pregnant and immunocompromised healthcare workers caring for patients with known or suspected novel H1N1 influenza infection. Again, currently available data along with practicalities, logistics and privacy concerns dictate that that CDC revisit its recommendation and not require reassignment of high-risk healthcare workers caring for patients with novel H1N1 influenza.

As policy-making bodies focus on the role of HAI prevention in healthcare reform and seek to expand their scope to the impact of HAIs in other healthcare settings, SHEA will continue to urge a focus on the scientific basis for prevention. The society will remain partnered with other like-minded professional organizations committed to reducing preventable infections in all healthcare settings in order to improve the quality of patient care and ensure better stewardship of our precious healthcare resources.

Mark E. Rupp, MD, is president of the Society for Healthcare Epidemiology of America (SHEA) and is professor in the Department of Internal Medicine, Section of Infectious Diseases at the University of Nebraska Medical Center.