Healthcare-Associated Infections Decline, but Further Reductions Needed

According to the Centers for Disease Control and Prevention’s (CDC) most recent progress report on healthcare-associated infections (HAI), rates of HAI declined markedly in recent years, although the trend did not extend to catheter-associated urinary tract infections (CAUTI). 

“The relative risk for HAI has decreased in the last 15 years due to improvements in awareness of risk associated with devices, infection control, and evidence-based practice regarding use of devices,” says Keith S. Kaye, MD, corporate vice president of quality and patient safety, and corporate director in the department of infection prevention, hospital epidemiology and antimicrobial stewardship of Detroit Medical Center and Wayne State University in Michigan.

The National and State HAI Progress Report provides an update on the progress toward eliminating HAIs, such as central line-associated bloodstream infections (CLABSI), CAUTI, select surgical site infections (SSI), hospital-onset Clostridium difficile infections (C. difficile), and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.

Significant National Reductions Identified in Nearly All HAIs

Specifically, the report highlighted significant national reductions in nearly all infections during 2013, with CLABSI and SSI demonstrating the strongest declines. “CLABSI infections saw a reduction of 46 percent during the period between 2008 and 2013. This is a dramatic reduction, as it means that half the numbers of people getting these infections just five years ago aren’t getting them. This means that fewer people had these types of infections and lives were saved,” says Arjun Srinivasan, MD, associate director for healthcare associated infection prevention programs in the division of healthcare quality promotion at the Centers for Disease Control and Prevention.

In addition, there was a trend toward reducing hospital-onset MRSA bacteremia and hospital-onset C. difficile infections. The report showed a 6 percent increase in CAUTI between 2009 and 2013, and early data from 2014 indicates a potential reduction in these infections as well.1,2

“While in this report, the data suggested an increase in CAUTI, data published after the publication of this report suggest more reductions in CAUTI, which is encouraging. I believe a change in awareness and mind shift change have made people begin to recognize that these infections, while not always life threatening can create a host of other problems and need to be avoided,” says Srinivasan.

Some hospitals and medical centers have made significant strides in improving CAUTI. “However, the issue with identifying CAUTI is that it can be difficult to differentiate colonization from symptomatic infection,” says Kaye.

According to Kaye one reason for the recent increase in CAUTI frequency is the CDC’s change in the definition of the disease. “Previously, patients with a urinary catheter who had a positive urine culture and a fever that could be attributed to a source other than the urine were not considered to have a catheter-associated urinary tract infection,” says Kaye. “However, in 2013, the CDC/NHSN [National Healthcare Safety Network] definition changed, and patients with a urinary catheter who presented with fever and a positive urine culture, were considered to have a CAUTI regardless of whether or not any other fever source might be present. This change alone has led to an approximate doubling of infection rates at some sites.”

Rapid Diagnostics to Help Reduce Rates of HAIs

The introduction of rapid diagnostics allows clinical practitioners to get information about infecting bacteria quickly. Information on the type of pathogen and resistant patterns can now be made available 24 to 48 hours sooner. “This provides an opportunity for [doctors] to implement effective antimicrobials more rapidly and to stop unnecessary broad-spectrum agents sooner. These types of interventions can improve patient outcomes and reduce antimicrobial resistance,” says Kaye.

Resistant Bacteria Organisms on the Rise

Despite the availability of rapid diagnostics, there has been a continued rise in the incidence of resistant organisms, specifically gram-negative organisms. “There has been some progress in the development and approval of newer antibiotics that offer activity against resistant gram negative organisms. Despite these newer agents, it remains a huge challenge to treat these infections,” says Kaye.

In addition, according to Srinivasan, there are a fair number of antibiotics to treat MRSA but gram-negative infections can be resistant, especially drug resistance gram-negative carbapenem-resistant Enterobacteriaceae (CRE) pathogens. Srinivasan emphasizes the importance of preventing these types of infections.

According to Kaye, hygiene is the most important and critical component of infection prevention. Clinical practitioners need to be extremely vigilant about hand washing as well as handling and managing patients’ implanted devices.

Medically reviewed by Pat F. Bass III, MD, MS, MPH

References

1. Healthcare-associated infections (HAI) progress report. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/hai/progress-report/index.html. Accessed: June 26, 2015.
2. National and State Healthcare Associated Infections Progress Report. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf. Accessed: June 26, 2015.