US groups set out strategy to reduce hospital acquired infections

BMJ 2008; 337 doi: (Published 10 October 2008) Cite this as: BMJ 2008;337:a2054
  1. Bob Roehr
  1. 1Washington, DC

    Five leading US healthcare organisations have united to reduce the rate of hospital acquired infections. The evidence based strategies aim to harmonise guidance and create practical tools for better implementation of infection control (Infection Control and Hospital Epidemiology 2008;29:S12-S21, doi:10.1086/591060). They focus on two specific organisms—meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile—and four vectors of infection—central line associated bloodstream infection, ventilator associated pneumonia, catheter associated urinary tract infection, and surgical site infection.

    The problem has been not a lack but a profusion of guidelines for infection control. They have been generated by multiple agencies in every one of the 50 states as well as by professional associations at state and national levels. Doctors have chosen to follow guidance that reflects their specialty and not embrace a common language.

    The five groups who developed the strategies are the Society for Healthcare Epidemiology of America; the Infectious Disease Society of America; the American Hospital Association; the Association for Professionals in Infection Control and Epidemiology; and the Joint Commission, which certifies healthcare facilities. In all 29 groups are supporting the effort in one form or another.

    David Classen, one of the authors of the new strategies speaking for the Infectious Diseases Society of America, said that he and his coauthors were “driven by the idea that it [the strategies document] had to be practical and implementation focused. It had to cut through all of the competing recommendations and not only tell us what to do, but how to do it.”

    The document identifies the responsibilities of individuals at every level of hospital staffing, including patients and families. It outlines infrastructure requirements and offers checklists for implementation. Wherever possible the guidance applies to both adults and children and provides measures to evaluate performance as the recommendations are implemented.

    The document lays out basic approaches and additional approaches if these don’t work. They also identify recommendations in other guidelines “that really shouldn’t be done.” Dr Classen thinks that is unique.

    Speakers at a press conference to launch the document said that improved patient safety was the leading factor behind the initiative. But they said it was no coincidence that this was unveiled just one week after changes in reimbursement by the federal Centers for Medicare and Medicaid Services went into effect. The nation’s largest single health payer will no longer pay for treating certain preventable hospital acquired infections.

    The Centers for Disease Control and Prevention estimates that every year two million US residents become infected while receiving medical care, and more than 90 000 die as a result of complications from infections. The cost to treat these preventable infections is estimated at between $4.5bn (£2.6bn; €3.3bn) and $6.5bn a year.

    Patrick Brennan, head of the federal Healthcare Infection Control Practices Advisory Committee, said that it was not possible to predict how the new strategies might affect hospital acquired infection because of the lack of uniform national reporting.


    Cite this as: BMJ 2008;337:a2054

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