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Healthcare-Associated Infections (HAIs)

More than MRSA

Across the healthcare landscape, from military medicine to Veterans Affairs to civilian settings, healthcare-associated infections (HAIs) continue to be a significant problem. These infections are acquired by patients while being treated for other illnesses in a healthcare setting – hospital, long-term care facility, or outpatient site – and can cause serious or life-threatening skin and wound infections, bloodstream infections, urinary tract infections, pneumonia, and others. These infections are often associated with surgical procedures or use of devices like intravenous lines, catheters, or ventilators. Many of the bacteria that cause these infections have developed resistance to antibiotics, making them more difficult to treat.

The U.S. Department of Health and Human Services (HHS) estimates that about one in every 20 inpatients has an infection related to hospital care, annually leading to tens of thousands of lives lost and costing billions of dollars in direct, indirect, and intangible expenses. In one specific example, a 2009 Government Accountability Office (GAO) report regarding HAIs in hospitals stated, “A 2007 study of 1.69 million patients who were discharged from 77 hospitals found that the additional cost of treating a patient with an HAI averaged $8,832.”

Quantifying the success of that bundle of interventions, a study showed a decrease of 62 percent in rates of healthcare-associated MRSA infection in intensive care patients from October 2007 to June 2010, and a decrease of 45 percent in non-ICU areas in VA hospitals nationwide.

Entities spanning the national healthcare spectrum have devoted significant attention in recent years to substantially reducing the incidence of HAIs. HHS identified the reduction of HAIs as an Agency Priority Goal for the department, and in 2008, a Federal Steering Committee for the Prevention of Health Care-Associated Infections was established, which included officials from the Department of Defense (DoD) and Department of Veterans Affairs (VA). That steering committee developed the “National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination” in 2009, and ongoing efforts have continued to develop and build on the strategies identified in that road map to meet the stated goal of significant and measurable reductions in certain specific HAIs – central line-associated bloodstream infections and catheter-associated urinary tract infections – by the end of fiscal year 2013.

MRSA HAIs

A scanning electron micrograph of a human neutrophil ingesting MRSA. National Institute of Allergy and Infectious Diseases photo

But even prior to that, in 2007, demonstrating the organization’s determination to mitigate the problem of HAIs, the VA instituted the MRSA Initiative – a bundle of measures put into place throughout VA acute care hospitals nationwide – designed to significantly reduce rates of MRSA, or methicillin-resistant Staphylococcus aureus, in VA healthcare facilities. That MRSA Initiative has been successful, and has served as a model for the VA’s continuing efforts to reduce HAIs caused by other pathogens.

“HAIs are a big problem in healthcare in general,” acknowledged Dr. Curtis J. Donskey, associate professor of medicine, Case Western Reserve University and staff physician, Infectious Diseases Section, Louis Stokes Cleveland VA Medical Center. More specifically, he explained, the VA healthcare system has a patient population that carries a great amount of risk for HAIs due to the number of elderly patients, who are particularly prone to getting infections like Clostridium difficile or MRSA, or those with weakened immune systems. “So, the problem is significant in the VA as it is elsewhere in healthcare,” he said.

Donskey, who also chairs the Infection Control Committee at the Cleveland VA Medical Center in Ohio, said that although MRSA remains one of the top healthcare-associated pathogens within the VA, the nationwide initiative the VA has had in place to reduce infections due to MRSA “has been a success.”

Since the initiative was put into action in 2007, Donskey said, they have seen a significant reduction in MRSA infections within the VA system, and those decreased infection rates have remained stable or continued to decline over the past few years.

“MRSA infections remain a major problem, but have decreased, in part, we think, due to some very successful interventions that the VA has implemented as a bundle,” he said.

That bundle includes four components: screening all incoming hospital patients for MRSA; isolating patients who are positive for MRSA to reduce risk for transmission; emphasizing hand hygiene; and instituting a cultural transformation, reinforcing that infection control is the responsibility of everyone who has patient contact.

Quantifying the success of that bundle of interventions, a study showed a decrease of 62 percent in rates of healthcare-associated MRSA infection in intensive care patients from October 2007 to June 2010, and a decrease of 45 percent in non-ICU areas in VA hospitals nationwide.

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