CDC REPORT ON PROGRESS IN CONTROLLING INFECTION IN U.S. HOSPITALS

FROM:  U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION 
Progress Being Made in Infection Control in U.S. Hospitals; Continued Improvements Needed

 CDC report provides first snapshot of state efforts to prevent MRSA and deadly diarrheal infections

Progress has been made in the effort to eliminate infections that commonly threaten hospital patients, including a 46 percent decrease in central line-associated bloodstream infections (CLABSI) between 2008 and 2013, according to a report released today by the Centers for Disease Control and Prevention.  However, additional work is needed to continue to improve patient safety. CDC’s Healthcare-Associated Infections (HAI) progress report is a snapshot of how each state and the country are doing in eliminating six infection types that hospitals are required to report to CDC. For the first time, this year’s HAI progress report includes state-specific data about hospital lab-identified methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections and Clostridium difficile (C. difficile) infections (deadly diarrhea).

The annual National and State Healthcare-associated Infection Progress Report expands upon and provides an update to previous reports detailing progress toward the goal of eliminating HAIs. The report summarizes data submitted to CDC’s National Healthcare Safety Network (NHSN), the nation’s healthcare-associated infection tracking system, which is used by more than 14,500 health care facilities across all 50 states, Washington, D.C., and Puerto Rico. Healthcare-associated infections are a major, yet often preventable, threat to patient safety. On any given day, approximately one in 25 U.S. patients has at least one infection contracted during the course of their hospital care, demonstrating the need for improved infection control in U.S. healthcare facilities.

“Hospitals have made real progress to reduce some types of healthcare-associated infections - it can be done,” said CDC Director Tom Frieden, M.D., M.P.H. “The key is for every hospital to have rigorous infection control programs to protect patients and healthcare workers, and for health care facilities and others to work together to reduce the many types of infections that haven’t decreased enough.”

This report focuses on national and state progress in reducing infections occurring within acute care hospitals. Although not covered by the report released today, the majority of C. difficile infections and MRSA infections develop in the community or are diagnosed in healthcare settings other than hospitals. Other recent reports on infections caused by germs such as MRSA and C. difficile suggest that infections in hospitalized patients only account for about one-third of all the healthcare-associated infections.

Tracking National Progress

On the national level, the report found a:

46 percent decrease in central line-associated bloodstream infections (CLABSI) between 2008 and 2013. A central line-associated bloodstream infection occurs when a tube is placed in a large vein and either not put in correctly or not kept clean, becoming a highway for germs to enter the body and cause deadly infections in the blood.
19 percent decrease in surgical site infections (SSI) related to the 10 select procedures tracked in the report between 2008 and 2013. When germs get into the surgical wound, patients can get a surgical site infection involving the skin, organs, or implanted material.
6 percent increase in catheter-associated urinary tract infections (CAUTI) since 2009; although initial data from 2014 seem to indicate that these infections have started to decrease. When a urinary catheter is either not put in correctly, not kept clean, or left in a patient for too long, germs can travel through the catheter and infect the bladder and kidneys.
8 percent decrease in MRSA bloodstream infections between 2011 and 2013.
10 percent decrease in C. difficile infections between 2011 and 2013.

Research shows that when healthcare facilities, care teams, and individual doctors and nurses, are aware of infection control problems and take specific steps to prevent them, rates of targeted HAIs can decrease dramatically.

Data for Local Action

The report provides data that can be used by hospitals to target improvements in patient safety in their facilities. For example, together with professional partners, CDC, the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organizations and Partnership for Patients initiative, and the Agency for Healthcare Research and Quality’s (AHRQ) Comprehensive Unit-based Safety Program (CUSP) increased attention to the prevention of catheter-associated urinary tract infections, resulting in a reversal of the recent increase seen in these infections. CAUTI data for early 2014 demonstrating these improvements will be publicly available on the CMS Hospital Compare website in 2015. CDC is also working to use HAI data to help identify specific hospitals and wards that can benefit from additional infection control expertise.

“Healthcare-associated infection data give healthcare facilities and public health agencies knowledge to design, implement and evaluate HAI prevention efforts,” said Patrick Conway, Deputy Administrator for Innovation and Quality and Chief Medical Officer of the Center for Medicare & Medicaid Services. “Medicare’s quality measurement reporting requires hospitals to share this information with the CDC, demonstrating that, together, we can dramatically improve the safety and quality of care for patients.”

“Successful programs such as CUSP demonstrate that combining sound HAI data with effective interventions to prevent these infections can have enormous impact,” said AHRQ Director Richard Kronick, Ph.D.

State Data

Not all states reported or had enough data to calculate valid infection information on every infection in this report. The number of infections reported was compared to a national baseline.

In the report, among 50 states, Washington, D.C., and Puerto Rico, 26 states performed better than the nation on at least two of the six infection types tracked by state (CLABSI, CAUTI, MRSA, C. difficile, and SSI after colon surgery and abdominal hysterectomy). Sixteen states performed better than the nation on three or more infections, including six states performing better on four infections. In addition, 19 states performed worse than the nation on two infections, with eight states performing worse on at least three infections.

The national baseline will be reset at the end of 2015. Starting in 2016, HAI prevention progress from 2016-2020 will be measured in comparison to infection data from 2015.

The federal government considers elimination of healthcare-associated infections a top priority and has a number of ongoing efforts to protect patients and improve healthcare quality. CDC provides expertise and leadership in publishing evidence-based infection prevention guidelines, housing the nation’s healthcare-associated infection laboratories, responding to health care facility outbreaks, and tracking infections in these facilities. Other federal and non-federal partners are actively working to accelerate the ongoing prevention progress across the country. In collaboration with CDC, these agencies use data and expertise to mount effective prevention programs and guide their work, including efforts of CMS Quality Improvement Organizations, the Agency for Healthcare Research and Quality’s Comprehensive Unit-based Safety Program,  and the National Action Plan to Prevent Healthcare-Associated Infections: Road Map to Elimination.

Preventing infections in the first place means that patients will not need antibiotics to treat those infections.  This can help to slow the rise of antibiotic resistance and avoid patient harm from unnecessary side-effects and C. difficile infections, which are associated with antibiotic use. Continued progress and expanded efforts to prevent HAIs will support the response to the threat of antibiotic resistance.

CDC WARNS OF DEADLY BACTERIA IMPACTING PATIENTS

The following excerpt is from the Centers For Disease Control website:

"Life-threatening germ poses threat across medical facilities
CDC highlights steps to prevent spread of deadly C. difficile bacteria, which impacts patients in nursing homes and outpatient care, not just hospitals

Infections from Clostridium difficile (C. difficile), a bacteria that causes diarrhea and other health issues, is a patient safety concern in all types of medical facilities, not just hospitals as traditionally thought, according to a new Vital Signs report today from the Centers for Disease Control and Prevention. Â While many health care-associated infections, such as bloodstream infections, declined in the past decade, C. difficileinfection rates and deaths climbed to historic highs.

“C. difficile harms patients just about everywhere medical care is given,” said CDC Director Thomas R. Frieden, M.D., M.P.H.  “Illness and death linked to this deadly disease do not have to happen. Patient lives can be saved when health care providers follow the 6 Steps to Prevention, which include key infection control and smart antibiotic prescribing recommendations.”

C. difficile is linked to about 14,000 U.S. deaths every year. Those most at risk are people who take antibiotics and also receive care in any medical setting. Almost half of infections occur in people younger than 65, but more than 90 percent of deaths occur in people 65 and older. Previously released estimates based on billing data show that the number of U.S. hospital stays related to C. difficile remains at historically high levels of about 337,000 annually, adding at least $1 billion in extra costs to the health care system. However, the Vital Signsreport shows that these hospital estimates may only represent one part of C. difficile’s overall impact.

According to Vital Signs, 94 percent of C. difficile infections are related to medical care. About 25 percent of C. difficile infections first show symptoms in hospital patients; 75 percent first show in nursing home patients or in people recently cared for in doctor’s offices and clinics. Â

Although the proportion of infection onset is lower in hospitals, these facilities remain at the core of prevention since many patients with C. difficile infections are transferred to hospitals for care, raising risk of spread within the facility.  The Vital Signs report shows that half of C. difficile infections diagnosed at hospitals were already present at the time the patient was admitted (present on admission), usually after getting care in other facilities. The other half were related to care given in the hospital where the infection was diagnosed.

The report highlights three programs showing early success in reducing C. difficile infection rates in hospitals.  Seventy-one hospitals in Illinois, Massachusetts, and New York decreased C. difficileinfections by 20 percent in less than two years by following infection control recommendations.  These promising results follow similar efforts in England, a nation that dropped C. difficile infections by more than 50 percent during a recent three-year period.Â

“C. difficile infections are usually a regional problem since patients transfer back and forth between facilities, allowing the disease to spread,” said L. Clifford McDonald, M.D., CDC medical epidemiologist and lead author of the study. “Health departments have the ability to work with many types of health care facilities, and have a unique opportunity to coordinate local, comprehensive prevention programs to reduce the occurrence of these infections.”

Patients get C. difficile infections most often within a few months of taking antibiotics and also receiving medical care. Antibiotics are lifesaving medicines that stop infections, but they also destroy the body’s good bacteria for several months.  During this time, patients can get sick from C. difficile picked up from contaminated surfaces or spread from a health care provider’s hands. Infection risk generally increases with age; children are at lower risk for C. difficile infection. Identifying C. difficile infection early and stopping its spread to other people can save lives.Â
Patients can help stop C. difficile by:

- Taking antibiotics only as prescribed by your doctor. Antibiotics can be lifesaving medicines.Â
- Telling your doctor if you have been on antibiotics and get diarrhea within a few months.
- Washing your hands after using the bathroom.
- Trying to use a separate bathroom if you have diarrhea, or being sure the bathroom is cleaned well if someone with diarrhea has used it.

CDC Vital Signs is a report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report (MMWR). Vital Signs is designed to provide the latest data and information on key health indicators – cancer prevention, obesity, tobacco use, alcohol use, prescription drug overdose, HIV/AIDS, motor vehicle passenger safety, health care–associated infections, cardiovascular health, teen pregnancy, access to health care, and food safety.