HAI Rates are a Red Herring

"Fictional" Hospital CMO: "Why should I care about hand hygiene or environmental cleaning if I have no CLABSI or CAUTI in my hospital?"

Don't take this the wrong way, since I'd never want a patient to develop a CLABSI or VAP, but I think our focus on device infections is actually harming patients in the long run. If we convince ourselves, like that CMO quoted above or QI and patient safety folks, that we can just prevent device infections (never mind define them away) and everything will be fine, we are missing the bigger picture. The bigger picture is antibiotic resistance and I've yet to see any evidence that our antibiograms are improving.

When did hospital epidemiologists forget we were infectious disease physicians?

In September's ICHE Kerri Thom and colleagues in Maryland published a sobering reminder that resistant pathogens are increasing, particularly Gram-negative pathogens. They (COI alert, I'm a co-author) completed an Acinetobacter baumannii prevalence survey of all mechanically ventilated patients in the state of Maryland. They swabbed intubated patients in 40 of 57 hospitals and collected sputum and/or perianal swabs from  92% of all eligible patients in those hospitals.  What they found was staggering.  Fully 34% of patients were colonized or infected with Acinetobacter baumannii with 16% in acute care settings and an astounding 63% in long-term care settings carrying the pathogen. Even more worryingly, many strains were highly drug resistant with 46% of isolates in long-term care described as "extensively drug resistant," meaning there were no effective therapies - polymixin anyone?

Why does this matter?  Resistant pathogens cause untreatable infections and result in terrible situations like patients being removed from organ transplant waiting lists. These pathogens also carry resistance genes and serve as reservoirs for emerging resistance in other pathogens like E. coli. So, while I'm sure these Maryland hospitals all report zero CLABSI or CAUTI, I guarantee that they all have patients infected and dying of Acinetobacter baumannii and other MDR-Gram negative pathogens. Until we make investments in the science behind hand hygiene improvement, environmental cleaning and other methods for transmission prevention and until we invest in antimicrobial discovery, patients will increasingly die of these untreatable infections.

Luckily, when a kidney transplant patient dies of MDR-Acinetobacter sepsis, the hospital CMO can still sleep at night. At least the patient didn't die of a CLABSI.  I'm sure the patient's family will find comfort in that.


red herring image source: misocrazy