Does anyone remember the SENIC (Study on the Efficacy of Nosocomial Infection Control)1 project published in 1980? It was a controlled study to evaluate the efficacy of infection control (IC) programs established between 1970 and 1976 in a representative sample of 13 hospitals. Most hospitals instituted IC programs in the 1960s-1970s but there were no scientific studies showing the efficacy of these programs. Administrators did not have a scientific basis for choosing alternative recommendations and therefore IC programs established by hospitals and the resources given to them varied widely. The follow-up SENIC study published in 1985 found that hospitals with an established surveillance program were able to reduce nosocomial infections.
The environment has changed since then:
- The recommendation of one infection preventionist (IP) per 250 beds was modified to one IP per 100 beds, based on the Delphi project.2
- The Internet provides access to the latest evidence to improve patient outcomes via Association for Professionals in Infection Control and Epidemiology (APIC), the Centers for Disease Control and Prevention (CDC), and many others. Examples include: the APIC Guide for the Prevention of Mediastinitis Surgical Site Infections Following Cardiac Surgery, the APIC Guide to the Elimination Catheter-Related Bloodstream Infections (CLABSI), Strategies to Prevent Catheter-Associated Urinary Tract Infections (CAUTI) in Acute Care Hospitals: 2014 Update.3
- The conventional wisdom from the SENIC project was that only about a third of hospital-acquired infections (HAIs) were preventable. Now, with increased emphasis on infection prevention and control, more data generation and analysis, and public reporting we are able to investigate performance improvement opportunities and apply published evidence-based principles to improve patient outcomes and prevent a greater proportion.
We have seen some good news. According to CDC in a report published in March 2016: 4
- The incidence of CLABSI in acute care hospitals reached the 2013 goal established by the HAI Action Plan,5 decreasing 50% during 2008 to 2014.
- CAUTIs in acute care hospitals decreased overall by 5% during 2013–2014 and declined 24% in non–intensive care unit settings since the baseline period.
- In long-term acute care hospitals, both CLABSIs and CAUTIs decreased, as have CAUTIs in inpatient rehabilitation facilities.
- The importance of preventing CAUTIs in all settings is highlighted by the frequency with which vancomycin-resistant enterococci, extended-spectrum beta-lactamase Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (especially in long-term acute care hospitals), cause these infections.
The not so good news is that C. difficile has been recently recognized as the most common HAI pathogen in acute care hospitals6 and in 2011, it caused an overall total of 453,000 infections, where 29,000 patients died within 30 days of diagnosis. The clostridium difficile infection SIR (Standardized Infection Ratio) in acute care hospitals decreased by only 8% overall during 2011–2014, and more concerning, increased 4% during 2013–2014. More work is needed to ensure that patients are safe from C. difficile.
IPs and all healthcare workers have worked diligently to improve patient outcomes by utilizing published evidence to eliminate HAIs. We still have work to do. Can we get to zero? Is C. difficile 100% preventable? Does one size fits all for implementing guidelines? How can your facility adapt recommendations for the best patient outcome? Do you have an electronic surveillance system that can assist with implementation of best practices? Can you give us examples of an instance where you improved patient outcomes?
- Haley RW, Ouade D, Freeman HE, et al: Study on the Efficacy of Nosocomial Infection Control (SENIC Project): Summary of study design. Am J Epidemiol 111:472-485, 1980.
- O'Boyle, Carol et al. Staffing requirements for infection control programs in US health care facilities: Delphi project. American Journal of Infection Control, Volume 30, Issue 6, 321 - 333
- Evelyn Lo MD, Lindsay E. Nicolle MD, Susan E. Coffin MD MPH, Carolyn Gould MD MS, Lisa L. Maragakis MD MPH, Jennifer Meddings MD MSc, David A. Pegues MD, Ann Marie Pettis RN BSN CIC, Sanjay Saint MD MPH and Deborah S. Yokoe MD MPH. Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology. Vol. 35, No. 5 (May 2014), pp. 464-479
- Weiner LM, Fridkin SK, Aponte-Torres Z, et al. Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals — United States, 2014. MMWR Morb Mortal Wkly Rep. ePub: 3 March 2016. Acessed March 9, 2016: http://dx.doi.org/10.15585/mmwr.mm6509e1er
- US Department of Health and Human Services. National action plan to reduce healthcare-associated infections. Washington DC: US Department of Health and Human Services; 2010. Accessed March 8, 2016: http://www.hhs.gov/ash/initiatives/hai/actionplan/index.html
- Magill SS, Edwards JR, Bamberg W, et al. ; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of healthcare-associated infections. N Engl J Med 2014;370:1198–208. Accessed March 9, 2016: http://www.hhs.gov/ash/initiatives/hai/actionplan/index.html