By Don Wright, M.D.
Healthcare associated infections (HAIs) account for an estimated 99,000 deaths and $28 billion to $33 billion in excess health care costs each year. But they are largely preventable and can be drastically reduced.
Recent research efforts in Pennsylvania, supported by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC), have shown that implementation of prevention recommendations can reduce HAI bloodstream infections by as much as 70% through targeted approaches.
The department of Health and Human Services (HHS) deputy secretary last year asked me to lead a coordinated departmental effort to reduce, prevent, and ultimately eliminate HAIs. HHS has a proven track record of successful infection prevention efforts. In 2008, we began a concerted, departmental-wide effort to marshal the extensive and diverse resources of HHS and cooperate effectively with public and private sector partners to accomplish the large-scale HAI prevention.
We established the senior-level “HHS Steering Committee for the Prevention of Healthcare-Associated Infections,” which includes the best clinicians, scientists and other public health leaders within HHS.
The steering committee last January released the initial version of an “Action Plan to Prevent Healthcare-Associated Infections,” a comprehensive policy document that establishes national goals and outlines key actions for enhancing and coordinating efforts.
I realized that if we tried to approach the problem too broadly, it would limit the effectiveness of our efforts. So, as an initial bite of the elephant, we decided to focus on hospitals and what I like to call the “Big Four” — catheter-associated urinary tract infections, central line-associated bloodstream infections, surgical site infections and ventilator-associated pneumonia.
The steering committee also wanted to address two organism-specific infections, so methicillin-resistant staphylococcus aureus (MRSA) bacteria and clostridium difficile infection also are included in the initial version.
The action plan outlines a multi-pronged public health approach to reducing and preventing HAIs. It prioritizes a research agenda and current infection-prevention recommendations from CDC; establishes criteria for assigning priorities to proposed research projects; outlines policy options for enhancing regulatory oversight of hospitals and encouraging reporting of infection rates; and sets projects for integrating data collection across HHS systems, progressing towards systems interoperability, accelerating the transition to electronic health record use, and reducing the data-collection burden on hospitals.
What gets measured tends to improve. Thus, a critical step in the process was identifying priority measures and five-year national prevention targets for assessing progress in HAI prevention.
We also are coordinating measure identification and target setting with existing departmental initiatives, including “Healthy People 2020,” a science-based, 10-year list of national objectives for promoting health and preventing disease. In Healthy People 2020, we plan to have a separate topic area focused on HAIs.
We want these strategies to be meaningful to those on the front lines of health care. We understand that this effort will be ineffective without the partnership of those at the state and local level, and every hospital in the United States.
There are key individuals and organizations that have made great progress in reducing infection rates, and we hope to coordinate all these efforts to support a true national effort to dramatically reduce infection rates.
What are the next steps?
We are hosting stakeholder meetings across the country to engage more organizations in this effort and gather additional input on how to enhance our strategies and meet our targets.
We also have begun implementing the action plan. Congress provided HHS with about $80 million through the 2009 “American Recovery and Reinvestment Act” and fiscal year 2009 omnibus appropriations legislation to support these initiatives.
Most of these funds will be sent to the states to expand state programs, support the use of CDC’s National Healthcare Safety Network for reporting, and enhance the inspection process of ambulatory surgical centers. We plan to show that we have been good stewards of these funds and expect to be held accountable for our efforts.
We also plan to launch a national media campaign aimed at multiple audiences — providers, institutions and consumers — to foster a team approach to preventing HAIs.
The campaign will initially be composed of materials in English and Spanish, but we hope to engage additional populations in future years. In coordination with health care provider training institutions, we are developing educational materials aimed at training the next generation of health care providers in infection control and prevention.
We want to foster a “culture of safety” in health care institutions, where the unit clerk, physician, nurse, environmental services worker, hospital administrative leader – as well as patients and visitors – are engaged in preventing HAIs.
I have seen great progress over the past year within HHS in developing a coordinated, comprehensive public health strategy to prevent HAIs, and have witnessed this initiative gain momentum across the country. More work needs to be done, but we are hopeful we can make progress in dramatically driving down infection rates.
Undoubtedly, reducing the impact of these infections across the nation will save lives and help us continue on our path to being a healthier, stronger and more compassionate nation.
Wright is HHS’ principal deputy assistant secretary for health. In an upcoming issue of AHA News, he will describe how HHS and hospitals are working to build a stronger partnership to combat HAIs.
