Keeping Our Eyes on the Antimicrobial Stewardship Ball: Dr. Tom Price as the next secretary of HHS

This is a guest post from Judy Guzman-Cottrill. Dr. Guzman-Cottrill is a Professor of Pediatrics at Oregon Health & Science University and also an infection prevention and healthcare epidemiology consultant for the Oregon Health Authority’s HAI Program, where she serves as the Medical Director for Ebola and Emerging Pathogen Preparedness. 


Many healthcare providers ponder what the incoming 2017 administration will mean for their work, including myself. Dan and Eli have already written several blog posts about public health funding threats. As my description above says, I'm a hybrid of sorts: a part-time pediatric infectious disease clinical faculty member at Oregon Health and Science University, and a part-time consultant to the Oregon State Health Department’s HAI program.

First, we’ve all been thinking about our patients and their families. The next administration’s plan for the Affordable Care Act seems to change constantly. During President-Elect Trump’s campaign, he promised to completely repeal the ACA within his first hundred days in office. Post-election, he has suggested that the ACA will be repealed or amended. After meeting with President Obama, Mr. Trump has stated that he will maintain the continued coverage for preexisting conditions and young adult coverage on parents’ plans until 26 years of age. Most recently, however, Mr. Trump selected Dr. Tom Price to serve as secretary of Health and Human Services. What will his leadership mean for our patients, including those who rely on Medicaid and Medicare? Dr. Price has also supported changes which would not require insurers to cover pre-existing conditions. Almost more concerning to me is that Dr. Price is a member of the Association of American Physicians and Surgeons (AAPS), an organization that vehemently opposes antibiotic stewardship legislation, has publicly opposed the IDSA Lyme Disease guidelines on several occasions, and whose executive director has publicly supported a potential link between MMR vaccine and autism as recently as 2015. Important note: It is unclear to me which of these specific stances are also personally supported by Dr. Price. It would be good to know.

What about public health, MDRO prevention, and infection prevention? I already mentioned the AAPS opposition to antibiotic stewardship legislation. Will all of our hard work be left to the wayside? Over the past decade, I've been amazed by the accomplishments our field has made in improving judicious antibiotic use. Our surgical and critical care colleagues are finally starting to feel comfortable with shorter days of antibiotic therapy, and narrower spectrum. Hospitals are starting to fund physicians and pharmacists along with the informatics experts necessary to develop and maintain effective stewardship programs. During clinical rounds, even ID consultants are asking themselves, “Does this patient really need more antibiotics? Or am I prescribing them a personal anxiolytic?!” Stewardship progress is everywhere, including NICUs across the country, partnering with the CDC, to decrease antibiotic exposure in neonates. I worry that Dr. Price, an orthopedic surgeon, will tout stewardship as needless control over physicians who should prescribe antibiotics to whomever, whenever they please.

ID clinicians and public health colleagues, let’s all keep an eye on Dr. Price. We should be strong, vocal advocates for our at-risk patients and our public health programs, to ensure that our infection prevention and healthcare epidemiology work continues into the next decade.

Partnership in Prevention Award

Have you assembled an effective team and achieved exceptional success in some aspect of infection prevention in your hospital or healthcare system? Then please consider submitting an application for the Partnership in Prevention award, an award jointly sponsored by SHEA, APIC and HHS to recognize such achievements. Read about the award, and instructions for applying, here. The application period is from today through July 1, 2013.

Embracing science, continued...

Also out today, the Department of Health and Human Services announces a new initiative entitled, "Partnership for Patients: Better Care, Lower Costs". From my initial reading, it looks like a 1 billion dollar investment, mostly in implementation of existing prevention approaches.

I'm sure we'll comment further as more details emerge, but I would like to highlight this paragraph from SHEA's statement on this initiative, which appropriately focuses on the need to advance the science of prevention (italics, for emphasis, are mine):

As the Obama Administration moves forward, we urge officials to think beyond the changes that past practice has suggested can make a difference, as well as the financial incentives and disincentives that ostensibly prompt providers to modify how they work. To really be successful, both now and in the long term, the NPSI must invest in the medical research and technology that will identify how the nation’s health system can avoid errors in care. The initiative also must be able to track and validate improvements through standardized measures and solid data. If we focus on implementation without advancing the science, we will fall short of immediate goals and risk being equally unprepared for future exigencies.

Photo credit: Kathleen Sebelius, HHS director, with Elmo. From the NY Daily News.

Addendum: Don't miss Bob Wachter's post on this initiative, here.

First HHS success story features the Keystone Project

Many of you have probably already seen this—the HHS Secretary, Kathleen Sebelius, is releasing a series of “healthcare success stories” meant to highlight innovative programs or initiatives. These programs are supposed to be models for how a reformed healthcare system would look.

The first success story is from the world of infection prevention, highlighting the Keystone Project. Yes, this is old news to us: any hospital with an infection prevention program should by now have implemented bundled interventions to reduce device associated infections. The challenge going forward will be to sustain reduced infection rates in the face of daunting financial pressures….if hospital layoffs increase, nurse:patient ratios fall, infection preventionist positions remain unfilled, and morale suffers, the team-based prevention approaches that have been so successful may come undone in some hospitals.