Federal officials are seeking significant reductions in some of the most common health care-associated infections over the next 5 years.
In a new “action plan,” the Department of Health and Human Services outlined goals related to six categories of health care-associated infections: central line-associated bloodstream infections, Clostridium difficile infections, catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) infections, surgical-site infections, and ventilator-associated pneumonia.
The seven national prevention targets identified in the HHS action plan call for the following:
▸Reducing the number of central line-associated bloodstream infections per 1,000 device days to below the current 25th percentile set by the National Healthcare Safety Network by location type.
▸Achieving full compliance with the central line bundle in nonemergent insertions.
▸Reducing by 30% the case rate per patient days and administrative/discharge data for ICD-9-CM-coded C. difficile infections.
▸Reducing by 25% the number of symptomatic urinary tract infections per 1,000 urinary catheter days.
▸Reducing by half the incidence rate of all health care-associated invasive MRSA infections.
▸Reducing the median deep-incision and organ-space infection rate for each procedure/risk group to at or below the current National Healthcare Safety Network 25th percentile.
▸Achieving 95% adherence rates for each Surgical Care Improvement Project/National Quality Forum infection process measure for surgical-site infections.
The national goals do not include targets for ventilator-associated pneumonia because HHS officials could not identify any valid outcome or process metrics for the condition. “This plan will serve as our road map on how the department addresses this important public health and patient safety issue,” said Mike Leavitt, former HHS secretary.
The goals outlined by the HHS are “reasonable,” said Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology. The action plan targets the most costly infections, both in terms of dollars and harm to patients, she said. The 5-year timeline also gives hospitals time to achieve reductions. At first, many hospitals may see increases in these infections, because the more you look, the more you find, Ms. Warye said.
The action plan may also play an important role by giving infection-control specialists more clout when they lobby their hospital administrators for resources for infection prevention, she said. “When the federal government gets into the act, it raises the stakes.”
The action plan also addresses concerns that there has been a lack of coordination among the various federal agencies and departments that have some responsibility for health care-associated infections, said Dr. Patrick J. Brennan, chairman of the Healthcare Infection Control Practices Advisory Committee. Dr. Brennan, who served on the steering committee that prepared the report, said that improved coordination is especially important at a time when federal budget dollars are tight.
For example, the HHS plan addresses the role of information technology as a way to improve coordination of federal departments with databases of infection information.
The action plan also outlines a research agenda related to the prevention of health care-associated infections. At the top of the agenda are research into the barriers to adherence of recommended infection-control practices, and strategies to overcome those barriers. For example, the report calls for demonstration projects that are focused on the prevention of surgical-site infection, C. difficile infection, and MRSA.
The HHS also called for more basic, epidemiologic, and translational research into how health care-associated pathogens are acquired. Many of the current infection-control practices are based on empirical observation, according to the HHS.
The plan is available at www.hhs.gov/ophs/initiatives/hai