Thursday, March 27, 2014

Left to our own devices

The big news today in healthcare-associated infection (HAI) prevention is the publication of the CDC’s Emerging Infections Program (EIP) point prevalence survey of HAIs, which includes burden estimates and an update on the epidemiology of HAIs in the US, circa 2011. Simultaneously, CDC released an update on national and state-level progress in HAI prevention. The CDC’s press release provides the bottom line messaging around these data: (1) we’ve made progress, and (2) we still have a long way to go.

One of the most important messages can be found in the abstract of the EIP point prevalence survey paper: 
“Device-associated infections (i.e., central-catheter–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care–associated infections, accounted for 25.6% of such infections.”
The device associated infections (DAIs), particularly CLABSI, are also the HAIs for which the most progress has been made in prevention. Why? Because we have prevention approaches that have been tested and implemented in most US hospitals. A common theme around the remainder of infections (now the great majority of HAIs) is that we have far less understanding about how exactly to prevent them (case in point: non-ventilator associated healthcare-associated pneumonia). 

If we expect to see further substantial reductions in HAIs, we’ll need more funding to support prevention studies for HAIs that aren’t device-associated, and for studies of prevention approaches that address HAIs that are beyond the reach of our rudimentary approaches to DAI prevention (e.g. bloodstream infections sourced to gut or skin in high risk patient populations like burn or bone marrow transplant). 

The assumption that we already know how to prevent most HAIs is patently ridiculous, and over the next few years we will see rates plateau as we gain the maximal benefit from improved hand hygiene and DAI prevention bundles. The next phase of infection prevention will require novel approaches.

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