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The Department of Health and Human Services (HHS) announces the availability for public comment of Phase 3 in the 5-year National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination (HAI Action Plan). The new Long-Term Care (LTC) chapter focuses on combating HAIs in nursing facilities and skilled nursing facilities. It extends earlier efforts that focused on acute care hospitals (Phase 1), ambulatory surgical centers and end-stage renal disease facilities (Phase 2), and influenza vaccination of healthcare personnel (Phase 2).
The LTC strategy proposes to expand the activities of multiple federal and nonfederal partners to combat HAIs prevalent in LTC settings, including urinary tract infection (UTI), lower respiratory tract infections, influenza and influenza-like illness, Clostridium difficile infection (CDI), and skin, soft tissue, and wound infections.
The chapter proposes that progress be assessed by tracking resident influenza and pneumonia vaccination rates and the rates of two HAIs:
1. Clostridium difficile infection (CDI) rates have reached epidemic levels among the general population. Hospitalization rates doubled from 2000 to 2005 and the death rate increased five-fold from 1999 to 2004. Hospitalization and death rates are disproportionately higher among persons aged 65 years and older. In at least one state, more than half of healthcare-associated CDI cases are estimated to manifest in nursing homes. The situation is complicated by increased rates of antibiotic resistance among older persons, which can make treatment more difficult.
2. Urinary tract infection (UTI), including catheter-associated UTI, or CAUTI, is the most commonly reported and treated infection in nursing homes and skilled nursing facilities. It is also a leading driver of 30-day hospital readmissions from those facilities. As with CDI, UTI treatment can be complicated by past antibiotic treatment. Unique diagnostic and management challenges for older patients also add complexity.
The chapter details strategies for addressing these issues. Proposed activities include expanded research, extended application of existing practice guidelines, development of new practice guidelines, provider implementation of national quality improvement initiatives, and payment policies that promote infection control and reduction.
HHS encourages comments from the general public, state and local health agencies, professional groups, foundations, Medicare and Medicaid-related organizations, insurers, business groups, and others. Comments may be submitted to OHQ@hhs.gov until 5 p.m.Â ET on Aug. 22, 2012.