Coordination of what?

I’m glad that the new CDC Vitals Signs report, based upon a modeling study of the impact of regionally-coordinated interventions to reduce healthcare associated infections (HAIs) due to selected multiple drug resistant organisms (MDROs) and C. difficile, is gaining some media attention. The investigators modeled three different scenarios for control: (1) status quo, (2) “augmented” efforts at selected individual facilities, and (3) augmented activities coordinated across a health care network. Using data from various sources to inform the model (Emerging Infections Program and National Healthcare Safety Network for disease burden; Orange County, California and the VA system for patient movement across healthcare facilities; and experience from the UK and Israel for reductions in MRSA, C. difficile, and carbapenem-resistant Enterobacteriaceae (CRE) after national interventions), the model suggests that prevention approaches coordinated by public health authorities could reduce HAIs due to CRE by 55-74%.

This analysis has several limitations, most of which are pointed out by the authors in their discussion—models are models. And I don’t think anyone disagrees that coordinating infection prevention activities across healthcare systems is a desirable goal. The sad fact, though, is that we are very far from achieving this goal. I think Judy Stone has a good take on this, here. Furthermore, even if public health funding were increased enough to provide resources for state and regional coordination of MDRO control, the impact would depend upon each facility’s capacity to implement basic infection control practices (as the authors point out, “Optimizing implementation of basic infection control practice within individual facilities will be of fundamental importance to this effort”).

So while we wait for the inevitable boost in public health funding that is sure to come from our current Congress, we should remain focused on improving the basic “horizontal” infection control practices of individual facilities. It is not possible to know in advance which patient harbors a life-threatening bacterial pathogen (resistant or not), so it is best to assume that everyone does.