Science-Based Strategies Take Aim at HAIs

For the first time, five healthcare leaders have collaborated to publish science-based strategies in a new compendium to help prevent the six most important healthcare-associated infections (HAIs). The work is called the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals.

Included in these strategies are the first-ever recommendations for detection and prevention of Clostridium difficile, and a detailed discussion on how to develop an active surveillance program for methicillin-resistant Staphylococcus aureus (MRSA). These strategies are practical, easy-to-use and intended to help acute care hospitals focus their efforts by identifying what they should and should not be doing. They also provide internal performance measures and specify accountability.

Representatives from the five groups, the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the AmericanHospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), and The Joint Commission, participated in a press conference held today at the National Press Club.

Infection preventionist Marsha Patrick, speaking on behalf of APIC, reminded those present at the press conference that APIC’s members have been among the ones bringing the science to the bedside and the ones working with hospital staff to reduce the risk of infection.

“Infection prevention is everyone’s business,” Patrick said. “The C-suite sets the tone for the entire organization.” Patrick explained that at her four-hospital system, they have gone from just one or two infection control practitioners, to six people. “Our CEO gets it,” Patrick said. “It’s a top-down effect, and programs must be adequately resourced by organizational leadership.”

Patrick reminded attendees that there must be buy-in by all stakeholders for infection prevention strategies to work. “We must get everyone on board with evidence-based guidelines. We know the best practices but we have to get them down at the bedside. But we must be adequately resourced, because our patients deserve good outcomes. It’s unfortunate that it has taken the Centers for Medicare and Medicaid Services (CMS) to withdraw reimbursement to get the C-suite’s attention, but it takes what it takes.”

Robert Wise, MD, vice president of the division of standards and survey methods of The Joint Commission, acknowledges the vast challenge of HAI prevention, and the fact that “few hospitals are completely effective” at targeting zero infections. He pointed to sicker patients, more complex procedures and devices, and tougher pathogens, making for a formidable mix of factors involved. However, Wise said he believes that the new compendium will serve as a way to strengthen current HAI prevention practices.

“Relevant, evidence-based guidelines must serve as the basis for infection prevention implementation strategies,” said Wise. "The Compendium meets a great need for clear, user-friendly language, and wasan important component in the development of The Joint Commission’s 2009 National Patient Safety Goals on HAIs, which include multi-drug resistant organisms, central line-associated bloodstream infections, and surgical site infections.”

Wise announced that in 2009, the Joint Commission will expect all hospitals to review their risks and determine which evidence-based practices need to be implemented. That same year, key stakeholders will convene to further review the guidance contained in this new compendium, and for 2010, the compendium’s requirements will be added to the Joint Commission’s standards for accreditation.

Richard J. Umbdenstock, president and chief executive officer of the American Hospital Association (AHA), concurred that HAI prevention is a major challenge but that the compendium is “a huge contribution” to prevention practices and also “represents professional consensus on infection prevention.” He called the compendium “accessible, understandable and actionable by every healthcare worker in the country.” Umbdenstock noted, “The nation’s infection control team now has a common playbook.” He added, “Hospitals welcome these strategies as clearly identifiable things that can be done to improve and measure their quality efforts. Working closely with this group has given us the opportunity to help ensure that this information can be put to work quickly on the front lines to make care better and safer for our patients.”

The compendium addresses the most common yet serious healthcare-acquired infections: urinary tract infections, ventilator-associated pneumonia (VAP), bloodstream infections, and surgical site infections. The compendium’s lead author, Deborah Yukoe, MD, MPH, a SHEA spokesperson, noted, “We reviewed the guidelines and the literature to choose recommendations that were best supported by the science.”

With the support or endorsement of an additional 29 healthcare organizations, theCompendiumis expected to be a good starting point for addressing this critical public health issue before it worsens.

“In developing these strategies, we looked at all existing HAI guidelines and literature to create recommendations that are understandable, easy-to-use and stress accountability,” said David Classen, MD, IDSA spokesperson and co-author of the strategies.

Six of the most important preventable HAIs with the greatest impact on morbidity and mortality were identified by the HAI Allied Task Force comprising the five collaborating partners. Recommendations are prioritized into two categories:

1)     Minimum basic practices that should be adopted by all acute care hospitals

2)     Special approaches for use in locations and/or populations within the hospitals when infections are not controlled using basic practices

Yukoe added, “The goal of all of us as healthcare providers is to offer the best and safest patient care possible. Not all HAIs are preventable, but it is imperative that we implement practices that we know are effective to prevent as many of these infections as possible. We know that relying on the best science available will help get us to that goal.”

“Adhering to evidence-based interventions to help eliminate preventable infections will be more important than ever before,” said APIC’s 2008 President Janet E. Frain. “Clinical and administrative leaders need to continue their support in making infection prevention a key patient safety initiative within their organization.  Patient safety is everyone's job.”

With patient concerns for HAIs growing, the five partnering organizations decided the time was right to review and synthesize current guidelines and develop practical strategies that could be readily implemented by healthcare professionals. The urgency is also heightened for acute care facilities to work toward eliminating HAIs. Beginning Oct. 1, 2008, CMS will no longer reimburse hospitals for costs related to treating certain HAIs.

Patrick J. Brennan, MD, chief medical officer for the Penn Health System, head of the federal Healthcare Infection Control Practices Advisory Committee (HICPAC) and president of SHEA, said that it is the consensus of the compendium authors that many more infections are now preventable. “It’s not a deficit of knowledge, but a deficit of implementation,” Brennan emphasized. “The challenge before us is keeping the information current, as knowledge and science progress.” Brennan added, "People should expect healthcare that is safe and free from additional complications. This effort will benefit healthcare providers, patients and their families, and just about everyone who walks in the hospital door because the strategies announced today identify what hospitals should be doing based on the latest scientific evidence and also provide  performance measures to ensure accountability. "

To access the compendium information, CLICK HERE.