and control
(Editor's note: This report contains an overview discussion of Infection Control trends and four pages of data on confronting hospital-acquired infections, strategies hospitals are implementing to prevent HAIs, assessing hand hygiene compliance, and examining the pace of progress on MRSA. To access all of the data tables in this report, simply click on the pdf download link below.)
The attention focused health care-associated infections (HAIs) continues to intensify. Outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) in schools, hospitals and other locations captured headlines around the country in 2008, underscoring the fact that MRSA is an emerging community pathogen as well. Meanwhile, recent studies have illustrated the growing problem of multidrug-resistant organisms in the hospital setting and the underlying problems in preventing the spread of HAIs.
The Association for Professionals in Infection Control & Epidemiology (APIC) conducted a national prevalence study of MRSA in U.S. health care facilities in the fourth quarter of 2006, releasing its findings in June of last year. Data showed that 46 of every 1,000 patients in the study were either infected or colonized with MRSA—a rate eight to 11 times greater than previous MRSA estimates.
An APIC Pace of Progress Poll of its 12,000 members conducted over a three-week period in April and May of 2008 found that the rise of more virulent strains of MRSA caused 76 percent of infection prevention and control professionals to implement additional MRSA intervention strategies within the past year.
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Institutions that adopted new interventions reported using a group of approaches to prevent the transmission of MRSA, including staff education, more aggressive hand hygiene programs and stricter use of contact precautions (e.g., gloves, gowns, etc.) for patients who test positive for MRSA. In addition, respondents placed more emphasis on housekeeping and equipment cleaning and decontamination practices, targeted patient screening, maintaining tracking systems to flag patients previously identified as having MRSA and taking other steps to try to stem the tide against the pathogen.
But in spite of these and other efforts, 54 percent of APIC respondents still believed their institutions were not doing as much as they could and should be doing to prevent MRSA.
Elsewhere, APIC, the Centers for Disease Control and Prevention and other organizations have continued to place emphasis on hand hygiene compliance and its role in effectively combating HAIs. A joint survey conducted in 2008 by Materials Management in Health Care, APIC and the Association for Healthcare Resource & Materials Management examined current methods being employed by hospitals to measure and enforce hand hygiene compliance. The data demonstrated that while preventing HAIs remains a top priority for infection prevention and control specialists, many continue to struggle with monitoring and enforcing hand hygiene protocols.
Major challenges to hand hygiene compliance reported by participants included staff not thinking about it (43 percent), being too busy (31 percent), having other patient needs take priority (25 percent) and not having role models (24 percent).
Meanwhile, regulatory and advocacy groups are putting greater pressure on hospitals to control infections and their costs. The Centers for Medicare & Medicaid Services (CMS) implemented a plan last October to eliminate reimbursement payments for certain infections that CMS deems preventable.
This article first appeared in the December 2008 issue of HFM.
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