The last half of 2013 has been eventful for infection control. The field has made technological, informational and even economic advances, with one study finally confirming what many have long suspected: investing in infection control is what every fiscally responsible hospital should do. While it's a few months early to be reviewing the full year's progress in infection prevention and control, in honor of International Infection Prevention Week, take a moment to review 10 major developments in the world of infection prevention since June.
1. Compounding pharmacies. While the major part of the fungal meningitis outbreak due to contaminated drugs from compounding pharmacies occurred last year, the Food and Drug Administration has reported 14 multi-state or national recalls associated with the contaminated drugs from compounding pharmacies in 2013, according to a Wall Street Journal report. The Centers for Disease Control and Prevention spent the entire month of June investigating bacterial and fungal contamination of methylprednisolone acetate at Nashville, Tenn.-based Main Street Family Pharmacy. This is the same drug that caused the 2012 outbreak, though the pharmacy then in question was the New England Compounding Center. The Government Accountability Office released a report on the need to strengthen FDA oversight of compounding pharmacies in July. Confirming the report, Cedar Park, Texas-based Specialty Compounding announced a recall of a product in August due to bacterial contamination, after the drug sickened 15 at several Texas hospitals.
2. The volume of adverse events. Adverse events abound in the U.S. healthcare system. A recent report updated IOM's 1999 "To Err is Human" report, which was based on data from 1986, with a review of deaths linked to adverse events between 2008 and 2011. In total, the new research estimated 440,000 deaths are linked to preventable adverse medical events every year. A subsequent report concluded 10 percent of hospitalizations worldwide (43 million of 421 million hospitalizations) result in adverse medical events, including several types of hospital-acquired infections, every year.
3. Brain disease scares highlight equipment processing. It happened first in August: Greenville Hospital System in Columbia, S.C., warned 11 patients they had possibly been exposed to Creutzfeldt-Jacob disease, a brain disease, after a patient who underwent surgery at the hospital. In September, eight patients at Manchester, N.H.-based Catholic Medical Services were also exposed to the disease, and an additional five patients in other states also may have been exposed after a patient with CJD had brain surgery at that facility. As it happens, the prions that cause CJD, which is incurably fatal, are not eliminated through the standard surgical cleaning process. While the hospitals in question followed infection control practices perfectly, given their information at the times of the infected patients' surgeries, the incidents put the spotlight on equipment sterilization, which is easy to botch due to its deeply specific nature. A study published in September found processing lapses for endoscopes may go undiscovered for several months or even several years.
4. The state of drug resistance. The CDC confirmed the difficulty of reducing adverse events related to infection with its first-ever report on the state of drug resistance, released in September. It revealed more than 23,000 antibiotic-resistant infections become fatal every year from the 2 million antibiotic-resistant infections contracted in total. Dishearteningly, the CDC also confirmed antibiotic use is the most important factor in controlling drug-resistant infections, while simultaneously noting more than 50 percent of antibiotic use is inappropriate.
5. The cost of HAIs. Researchers went back into the archives and used data from 1986 to 2013 to calculate the annual cost of healthcare-associated infections, which turned out to be a hefty $9.8 billion annually in the U.S. alone. Central-line associated bloodstream infections were the most costly on a per-patient basis, while surgical site infections were the most common. A later report took a farther-reaching systemic look and revised that estimate upward — way upward — to $147 billion annually in direct and indirect societal costs to the U.S. While that's only 5 percent of the total healthcare spend in 2012 (Forbes estimates $3 trillion), it's still a hefty sum.
6. CDC reports progress in battling HAIs. Full disclosure: This story is from February, but its continuing importance merits it a place on the list. A CDC analysis of data from the period 2008 to 2001 showed a 41 percent reduction in CLABSIs, a 17 percent reduction in SSIs and a 7 percent reduction in catheter-associated urinary tract infections (between 2009 and 2010). While HAIs may be costly and adverse events plentiful, U.S. hospitals are continuing to improve their track records when it comes to preventable harms and infection control.
7. Inconsistent reporting plagues the system. Of course, there's always room for improvement. A Colorado study showed public reporting for CLABSIs is lacking, with individual reports varying greatly in terms of surveillance practices and definition criteria. Researchers suspected the problem was of a wider scope and probably systemic in nature. Another study showed as many as 100 percent of SSIs went unreported when patients were admitted to different hospitals for treatment than the hospitals at which they had received surgery. A third study emphasized the importance of committing to developing and enforcing a standardized system of reporting if the U.S. hopes to continue improving HAI surveillance and reduction.
8. Reporting grows. It's important to keep in mind reporting is usually a good faith effort. The CDC's report on drug-resistant bugs was an important milestone in infection control, providing healthcare facilities nationwide with a better picture of what they are up against on a regular basis. In another first, Kansas' Department of Health and Environment released its first-ever report on HAIs in its hospitals. While Kansas, Michigan and Wisconsin do not currently require providers to report infection rates to the state, Kansas has already requested and is collecting 2012 data from its hospitals. The reporting system may require a makeover sometime soon, however, as a recent study found state-required reporting didn't do much to CLABSI rates, which was the purpose for which the legislation was initially created.
9. Updates on some nefarious characters: MRSA and C. diff.: The studies are numerous. After all, Methicillin-resistant Staphylococcus aureus and Clostridium difficile are among the big, bad pathogens in hospital settings.
MRSA hospital onset rates declined more than 54 percent between 2005 and 2011 in major metropolitan areas nationwide, and total MRSA rates were down more than 40 percent between 2005 and 2011. Research also showed clinicians prescribe antibiotics for MRSA based on national, rather than local, rates of the infection. Another study showed gloves and gowns do little to stop the spread of MRSA in hospital settings.
C. diff acquisition in U.S. hospitals doubled between 2001 and 2010. According to one study, this increase may be in part due to improved molecular detection of the bug. Another study unraveled C. diff genetics in pursuit of its sources and found half of C. diff infections in hospitals begin in communities outside of the hospital, which was an important revelation, as another study showed hospitals vary greatly in their tracking of community sources of the infection. In the treatment arena, a study demonstrated low-dose antibiotics can be as effective as high-dose antibiotics for treating C. diff.
10. Hand hygiene compliance continues to be controversial. While recent research has shed light on shortfalls in hand hygiene, this creates plenty of opportunities for improvement. Some recent findings are not so surprising: All student nurses have observed breaches in hand hygiene protocol, patients are reluctant to remind providers to participate in hand hygiene and more comprehensive monitoring systems greatly increase hand hygiene compliance. Some hand hygiene findings are more surprising: Nurses have better hand hygiene compliance than physicians, younger medical students think hand hygiene is more important than residents, hand hygiene compliance is not related to workload and compliance dips the most during the summertime.
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