America is doing a better job of preventing healthcare-associated infections (HAIs), but more work is needed – especially in fighting antibiotic-resistant bacteria. The CDC’s latest report urges healthcare workers to use a combination of infection control recommendations to better protect patients from these infections.
“New data show that far too many patients are getting infected with dangerous, drug-resistant bacteria in healthcare settings,” said CDC Director Tom Frieden, M.D., M.P.H. “Doctors and healthcare facilities have the power to protect patients – no one should get sick while trying to get well.”
Many of the most urgent and serious antibiotic-resistant bacteria threaten patients while they are being treated in healthcare facilities for other conditions, and may lead to sepsis or death. In acute care hospitals, one in seven catheter- and surgery-related HAIs can be caused by any of the six antibiotic-resistant bacteria listed below. That number increases to one in four infections in long-term acute care hospitals, which treat patients who are generally very sick and stay, on average, more than 25 days.
The six antibiotic-resistant threats examined are:
- Carbapenem-resistant Enterobacteriaceae (CRE)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases)
- Vancomycin-resistant Enterococcus (VRE)
- Multidrug-resistant Pseudomonas aeruginosa
- Multidrug-resistant Acinetobacter
The national data in this report, along with data from the CDC’s latest annual progress report on HAI prevention, show that acute care hospitals have achieved a 50 percent decrease in central line-associated bloodstream infections (CLABSIs) between 2008 and 2014. They have also achieved a 17 percent decrease in surgical site infections (SSIs) between 2008 and 2014 related to 10 procedures tracked in previous HAI progress reports.
No change was found in the overall catheter-associated urinary tract infections (CAUTIs) between 2009 and 2014. During this time, however, there was progress in non-ICU settings, progress in all settings between 2013 and 2014, and most notably, even more progress in all settings towards the end of 2014.
The report also examines the role of Clostridium difficile (C. difficile), the most common type of bacteria responsible for infections in hospitals. C. difficile caused almost half a million infections in the United States in 2011 alone. The CDC’s annual progress report shows that progress has been made in decreasing hospital-onset C. difficile infections by eight percent between 2011 and 2014.
Along with the updated annual progress report, the CDC released the Antibiotic Resistance Patient Safety Atlas, a new web app with interactive data on HAIs caused by antibiotic-resistant bacteria. The Atlas uses data reported to the CDC’s National Healthcare Safety Network from 2011 to 2014 from more than 4,000 healthcare facilities.
The CDC is calling on doctors, nurses, health care facility administrators, and state and local health departments to continue to do their part to prevent HAIs. The report recommends doctors and nurses combine three critical efforts to accomplish this. First, prevent the spread of bacteria between patients; then prevent infections related to surgery and/or placement of a catheter; and improve antibiotic use through stewardship.
Staff can prevent infections from catheters and after surgery by using catheters only when necessary, follow recommendations for safer insertion and care and remove catheters from patients as soon as they are no longer needed. They can prevent bacteria from spreading by improving hand hygiene, and using gloves, gowns and dedicated equipment for patients who have resistant bacteria. Finally the staff can improve antibiotic use by getting cultures and start antibiotics promptly. They should use cultures to reassess the need for antibiotics, and stop antibiotic treatment as soon as they are no longer needed.
“For clinicians, prevention means isolating patients when necessary,” said Clifford McDonald, M.D., Associate Director for Science at the CDC’s Division of Healthcare Quality Promotion. “It also means being aware of antibiotic resistance patterns in your facilities, following recommendations for preventing infections that can occur after surgery or from central lines and catheters placed in the body, and prescribing antibiotics correctly.”
The CDC efforts, in addition to efforts by the Centers for Medicare and Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ), and state mandates for public reporting of HAIs, have all contributed to national progress in improving transparency, accountability, and quality related to patient safety.
“The good news is that we are preventing healthcare acquired infections, which has saved thousands of lives,” said Patrick Conway, M.D., M.Sc., Deputy Administrator and Chief Medical Officer at Centers for Medicare and Medicaid Services. “The challenge ahead is how we help to prevent antibiotic resistance as well as infections. We are using incentives, changes in care delivery, and transparency to improve safety and quality for patients.”
Congress has recognized the urgent need to combat antibiotic resistance. In fiscal year 2016, Congress appropriated $160 million in new funding for the CDC to implement its activities listed in the National Action Plan for Combating Antibiotic-resistant Bacteria. With this funding, the CDC will fight the spread of antibiotic resistance by accelerating outbreak detection and prevention in every state and enhancing tracking of resistance mechanisms and resistant infections. The CDC will also be supporting innovative research to address current gaps in knowledge, and improving antibiotic use. When antibiotics are necessary, use the appropriate antibiotic in the proper dosage, frequency and duration.
See the CDC Announcement
See the CDC Report
See also Medical Law Perspectives, January 2012 Report: Hospital-Acquired Infections: Who Is Liable and Why? (to be updated Summer 2016)