Healthcare-Associated Infections _ ______________________________________________________________
In 2016, the HHS released targets and measures for phase one of the HAI Action Plan using data from 2015 (baseline) to 2020. The measures reflect national progress on reduction of HAIs in acute care hospitals ( Table 2 ) [2]. The CDC’s 2023 annual National and State Healthcare-Associated Infections Progress Report provides a summary of select HAIs across four healthcare settings, including acute care hospitals [17]. Overall, CLABSI, CAUTI, MRSA, and CDI continued to decline in 2023 compared with 2022, with CAUTI, MRSA, and CDI below standardized infection ratios [17]. Evidence-based guidelines are at the heart of strategies to prevent and control HAIs and drug-resistant infections and address a wide range of issues from architectural design of hospitals to hand hygiene ( Table 3 ) [18; 19; 20; 21; 22; 23; 24; 25; 26; 27; 28; 29; 30; 31; 32; 33; 34; 35; 36; 37; 38; 39; 40; 41]. Adherence to individual guidelines varies but, in general, is low. For example, hand hygiene is the most basic and single most important preventive measure, yet compliance rates among healthcare workers have averaged 30% to 50% [29; 42; 43; 44; 45]. Decreasing the number of HAIs will require research to better understand the reasons behind lack of compliance with guidelines and to develop education and interventions that target those reasons. “Zero tolerance” of HAIs became a common catch-phrase as a call to improve prevention strategies and eliminate HAIs. Zero tolerance for HAIs is a worthy goal, but the complete elimina- tion of all HAIs is not feasible, primarily because interven- tions address only exogenous sources of infection and do not address many other important factors, such as host response, patient case mixes, pathogen virulence, and lack of specificity in definitions and diagnostic criteria [46; 47]. Furthermore, the literature has not supported the complete elimination of HAIs with enhanced compliance to prevention protocols. The results of the CDC’s Study of Efficacy of Nosocomial Infection
Control (SENIC) suggested that 6% of all HAIs could be pre- vented by minimal infection control efforts and 32% by “well organized and highly effective infection control programs” [48; 49]. A later review of 30 studies suggested that an estimated 20% of HAIs are preventable [50]. A 2011 study estimated that approximately 65% to 75% of central line-associated bloodstream infections and catheter-associated urinary tract infections were preventable using current evidence-based strate- gies; 55% of ventilator-associated pneumonia and surgical site infections were estimated to be preventable [51]. Furthermore, complete elimination is not needed to reap substantial benefit. The U.S. Department of Health and Human Services estimates that a 40% decrease in preventable HAIs (compared with the 2010 rate) would result in 1.8 million fewer injuries and more than 60,000 lives saved over 3 years [10]. A 70% decrease in the rate of HAIs would save an estimated $25 to $31.5 billion [1]. The results of studies evaluating strategies to prevent HAIs have shown a wide range in efficacy, particularly with respect to specific HAIs. For example, the effectiveness of strategies to prevent surgical site infections has not been consistent, with some studies showing significant improvement and other studies showing no substantial improvement [52; 53; 54]. Still, research has shown that strict adherence to prevention inter- ventions has an effect; one study demonstrated a decrease of as much as 66% in the prevalence of intravascular device-related bloodstream infections with adherence to a combination of interventions [55; 56; 57; 58; 59]. Combinations of interven- tions, or “bundles,” have been found to be the most effective for preventing HAIs, and the Institute of Healthcare Improve- ment (IHI) has developed how-to guides on implementing these bundles, which are available for download from the IHI website (https://www.ihi.org/insights/what-bundle) [60; 61; 62]. More research is needed to determine the direct impact of many guideline recommendations and the combinations of “best practices” that yield the lowest rates of individual HAIs.
PROGRESS a : NATIONAL ACUTE CARE HOSPITAL HAIs
Measure and (Data Source)
Progress 2016
Progress 2019
Target 2020
CLABSI (NHSN) CAUTI (NHSN)
11% reduction 7% reduction 8% reduction 6% reduction 8% reduction 6% reduction 4% reduction
31% reduction 26% reduction 5% increase b 18% reduction 42% reduction 7% reduction 29% reduction
50% reduction 25% reduction 50% reduction 50% reduction 30% reduction 30% reduction 30% reduction
Invasive MRSA (NHSN/EIP) Hospital-onset MRSA (NHSN) Hospital-onset CDI (NHSN)
SSI (NHSN) b
Clostridioides difficile -related hospitalizations (HCUP)
a Progress from baseline of 2015 b CDC data for 2019 delayed for this measure due to COVID-19 within EIP data source.
CDI= Clostridioides difficile infection ; CLASBI=central line-associated bloodstream infections; CAUTI=catheter- associated urinary tract infections; EIP=Emerging Infections Program; HCUP=Healthcare Cost and Utilization Project; MRSA=methicillin-resistant Staphylococcus aureus ; NHSN=National Healthcare Safety Network; SSI=surgical site infection. Source: [2] Table 2
68
EliteLearning.com/Dental
Powered by FlippingBook