commentary
HEALTH CARE-ASSOCIATED INFECTIONS: WHAT WE’VE LEARNED
BY CHARLES J. LERNER, MD, AND JANE D. SIEGEL, MD Physicians have been trained to find the causes of medical problems, and that includes health care-associated infections (HAIs). Strong evidence suggests it’s no lon- ger acceptable to say a patient became infected because he or she was in a high-risk group or was just so sick that infection was expected. In 2002, the U.S. Centers for Dis-
ease Control and Prevention (CDC) estimated 1.7 million patients annually developed HAIs. There were an esti- mated 99,000 deaths associated with those infections, according to a study published in Public Health Reports in 2007. In 2011, the annual burden of HAIs
in U.S. acute care hospitals was 722,000, and 75,000 of those patients died. CDC data show decreases in HAI rates and associated death rates as health facili- ties consistently implement effective evidence-based, bundled practices for prevention of device-related infec- tions and surgical site infections. HAI prevention is now a key component of patient safety programs.
We must have no tolerance for fail- ing to follow established best practices. In our personal experience treating adults and children, several large hos- pital intensive care units (ICUs) have, with process improvement, dramati- cally reduced central line-associated bloodstream infection (CLABSI) rates, making a CLABSI a rare event. At least one of these ICUs hasn’t had a CLAB- SI in more than two years. Each CLABSI is now approached
with a formal root cause analysis to see if anything could have been done differently to prevent the infection. Data from 2014 show the number of HAIs in long-term acute care hospi- tals is also decreasing. These lessons from well-designed
studies have led to zero tolerance for HAIs:
• Most HAIs are preventable. • Hand hygiene before and after con- tact with patients and items and surfaces in their immediate envi- ronment saves lives.
• HAIs in all facilities where health care is delivered contribute to ad-
verse patient outcomes, and most are preventable.
• Prevention of HAIs requires a mul- tidisciplinary approach that uses root cause analysis and the imple- mentation of optimal prevention bundles (combination of several evidence-based practices) with audits and feedback to assure con- sistent practice, especially within specialized high-risk populations.
• Limiting the use of medical de- vices to only necessary indications rather than convenience leads to improved patient outcomes and reduced HAI rates.
• In the absence of an outbreak, a horizontal approach that includes preventive practices, such as hand hygiene, standard precautions, and reduced use of devices for all patients is more effective than a vertical approach based on active surveillance cultures for a specific organism and contact precautions when that organism is present. A commentary accompanying the
“Compendium of Strategies to Pre- vent Healthcare-Associated Infec- tions in Acute Care Hospitals: 2014 Updates,” published in Infection Control and Hospital Epidemiology, discusses how the horizontal ap- proach targets prevention of infec- tions caused by a broad spectrum of infectious agents.
We must have no tolerance for failing to follow established best practices.
February 2017 TEXAS MEDICINE 15
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