New Infection Control Guidelines

I recently attended the SHEA/CDC Training Course in Healthcare Epidemiology in Seattle, WA. It offered hands-on workshops on the fundamental aspects of healthcare epidemiology including epidemic investigation.

Not that I now can investigate an outbreak all on my own, but I understand the principles and have a better appreciation of the magnitude of the job of an infection control physician. I found it to be a great supplement to the IDSA/SHEA Infection Control Fellows Course which was an online course required by my fellowship program last year.

At the course, one of the speakers mentioned that new infection control guidelines were to be released this week. Well yesterday, the release of The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals was announced. For the first time, major leaders in healthcare came together to publish practical evidence-based strategies to help hospitals prevent the six most important healthcare-associated infections. This is one journal that is not going to end up in the growing pile of journals on my living room floor that threatens to avalanche.

The leading organizations

SHEA – Society for Healthcare Epidemiology of America
IDSA – Infectious Diseases Society of America

APIC – Association for Professionals in Infection Control and Epidemiology, Inc

JCAHO – The Joint Commission on the Accreditation of Healthcare Organizations

AHA – American Hospital Association

The infections of interest

1. MRSA – Methicillin-resistant Staphylococcus aureus
2. CDI – Clostridium difficile infection
3. CLABSI – Central line-associated bloodstream infection
4. VAP – Ventilator associated pneumonia
5. CAUTI – Catheter-associated urinary tract infection
6. SSI – Surgical site infection

A brief glance through my ID consult roster shows how common these infections are.

It is estimated that 2 million Americans get an infection while receiving medical treatment and that greater than 90,000 die as a result of complications from an infection annually. Hospital infections cost an extra $4.5-6.5 billion each year.

I remember when it was first announced that Medicare and Medicaid would no longer reimburse hospitals for costs related to treating certain HAIs such as a catheter-related urinary tract infection, I thought to myself how absurd! But when you think about it, there is no good reason a 50-year-old man who is in the hospital for a pneumonia and nothing else should need a urinary catheter. So I guess making the hospital responsible for complications that result from this misuse is reasonable. I think back to rounds as an intern at Brown Rhode Island Hospital where my attending or senior resident never failed to ask “does the patient have a Foley? … why does he have a Foley?” Responses such as “the ER put it in”, “the nurses didn’t want to remove it”, and “the patient is fine with it in” were not satisfactory answers.

Well, it’s no use being a pessimist in medicine. While not every single healthcare-acquired infection (HAI) is absolutely preventable, it is true that a lot more can be done to decrease the numbers. The new guidelines are actually not very different from the existing HAI prevention guidelines. Hopefully the number and the importance of the endorsing organizations will however give the recommendations some strength. They are written more concisely, state what not to do in addition to what should be done, with the burden on each hospital to be accountable for HAIs. I think it should be reading material for anyone who works in a hospital.

It would be interesting to see what the impact of these guidelines will be. As I said, nothing is majorly new and a lot of the guidelines are very basic such as “Wash your hands before …” which we all should already be doing. The problem with our infection control efforts is not in the dearth of literature and guidelines but rather in the lack of action on the part of each physician, nurse, phlebotomist, food-delivery person, and other ancillary staff, but also on the part of various departments and a hospital as a whole.

We need one of these alarm bells from the Far Side comic strip at the entrance of each patient’s room, the foot of each bed, the operating rooms etc….