Healthcare-Acquired Infections Not Reported Enough

October 23, 2020
Frank Diamond

Conference | <b>ID Week</b>

Too many hospitals apparently do not use the CDC’s Hospital Toolkit for Adult Sepsis Surveillance, which may explain the number of healthcare-acquired infections that remain unreported.

Too many healthcare-acquired infections (HAIs) are not reported to the US Centers for Disease Control and Prevention (CDC), and the special toolkit the CDC devised to battle HAIs isn’t utilized enough, according to a study (“Clinical Correlates of CDC’s Hospital-onset Adult Sepsis Event Surveillance Definition and Association with Reportable Healthcare-Associated Infections”) unveiled at ID Week. The toolkit is the Hospital Toolkit for Adult Sepsis Surveillance, but as is the case with any tool, it’s only good if you use it. And most hospitals don’t use it to report healthcare-acquired infections (HAIs) conclude investigators with Massachusetts General Hospital, Harvard Medical School, and the Harvard Pilgrim Health Care Institute.

“CDC’s hospital-onset ASE definition accurately identifies patients with nosocomial sepsis who have very high mortality rates and are generally not captured by currently reportable HAI metrics,” the study states. “Routine hospital-onset ASE surveillance could provide a broader window into serious nosocomial infections, identify new targets for prevention, and further improve outcomes for hospitalized patients.”

Investigators examined data on all adult patients who’d been admitted to an academic medical center between June 2015 and June 2018. They looked at the overlap of hospital onset sepsis (HO) and ASEs that were reported to the National Healthcare Safety Network (NHSN). They then reviewed 110 HO-ASE cases.

Investigators looked at data from 168,249 patients, including 2139 (1,3%) with HO-ASE and 2133 with HAIs that had been reported to the NHSN. “HO-ASE associated mortality was high even when NHSN-reportable HAIs were absent (26.5%) whereas NHSN-reportable HAI mortality was relatively low when HO-ASE was absent (8.4%),” the study states. “Amongst the 110 reviewed HO-ASE cases, 102 (93%) were possible or confirmed infections, most commonly pneumonia (39%, of which 35% were ventilator-associated), non-C.difficile intra-abdominal infections (15%), febrile neutropenia (14%), urinary tract infection (7%, of which 88% were catheter-associated), and skin/soft tissue infection (7%).

Investigators point out that “most (86%) infections flagged by HO-ASEs were acquired in the hospital rather than the community. The most common non-infectious events flagged by HO-ASE were pulmonary edema and periprocedural blood loss associated with blood cultures and empiric antibiotics.”

One of the problems with controlling HAIs has to do with the growth of antibiotic resistant pathogens. Kevin Kavanagh, MD, a member of the Infection Control Today®’s Editorial Advisory Board, noted in an article that 500 people in the United States die each day from antibiotic resistant organisms. As mentioned, the data collected for the ID Week study are pre-COVID.

Kavanagh wrote that preliminary data revealed that “patients with COVID-19 were more likely to contract healthcare-acquired infections (HAIs), possibly due to longer hospital stays. The most common MDRO infecting patients with COVID-19 was methicillin-resistant Staphylococcus aureus (MRSA), followed closely by extended spectrum beta-lactamases (ESBL)-producing organisms. MRSA caused just under half of the COVID-19 hospital-acquired antibiotic resistant infections.”

That was also the finding of another study unveiled at ID Week. That study looked at what happened when the Denver Health Medical Center sectioned off part of their facility for COVID-19 only. Investigators found that catheter-associated urinary tract infections (CAUTIs) were 83% higher for the COVID patients compared to the non-COVID patients. They also found that central line-associated bloodstream infections (CLABSIs) were 65% higher for COVID patients compared to non-COVID patients.