ARLINGTON, VA—Eighteen months ago, the Department of Health and Human Services received a less than stellar grade on its efforts to prevent hospital infections. A Government Accountability Office report released in March 2008 and titled “Continuing Leadership Needed from HHS to Prioritize Prevention Practices and Improve Data on These Infections” pointed to a need for the agency to better coordinate efforts and identify what their highest priorities should be as far as hospital associated infections (HAIs) were concerned.

Speaking at a conference on hospital infections here last month, Dr Don Wright, principal deputy assistant secretary for health, said that HHS has since created a nationwide action plan for HAI prevention, one that it hopes to disseminate across the county and down to the level of state government.

National Priorities

“To be honest, [the GAO report] pointed to a lot of areas it felt that HHS came up short,” Dr Wright admitted. “[HHS is the] 7th largest world economy, and in an organization that large, it is very easy to work in silos and not know what some of your sister agencies were doing, which was one of the main criticisms in the report.”

Following the GAO report, HHS leaders formed a senior-level steering committee with the intention of creating an agency-wide initiative laying out what HHS’s plan should be, and where it should direct its resources. The action plan created a list of HAI priority areas, all of which focused on preventing infections in the hospital setting: catheter-associated urinary tract infection, central line-associated blood stream infection, surgical site infection, ventilator-associated pneumonia, and two specific organisms of concern, MRSA and Clostridium difficile.

These represent HHS’s tier one priorities when it comes to HAI. Its tier two priorities, which have not been fully established yet, will address other types of health care facilities. “We took a great deal of criticism in this tiered approach,” Dr Wright said. “A lot of comments pointed at ambulatory care [as a top source of infection spreading], and that’s important, but we chose to focus on hospitals.”

There are approximately 1.7 million HAIs in hospitals in this country every year, which result in 99,000 deaths. If hospitals were to implement the current best prevention practices, it could potentially result in a 70% reduction in HAIs. HHS has held five stakeholder engagement meetings around the country, the last held last month in Seattle. The goal has been to engage the general public, hospitals, and medical professionals in the action plan, as well as to request input on priorities and strategies. The meetings were frequently booked to capacity well in advance, Dr Wright said.

Trickling Down to the State Level

It is at the state and local level, where hospitals actually operate, that the plan put forth by HHS needs to be implemented if the agency wants to see success in the form of decreased HAI. The carrot for states has been stimulus package funding specifically for state HAI programs, expanding the National Healthcare Safety Network, and hospital training in HAI prevention. The stick is wording in the 2009 Omnibus Appropriation’s Act that requires states receiving Preventive Health and Health Services block grant funds to submit a state action plan to the HHS Secretary no later than January 1, 2010, or CDC is authorized to withhold 25% of that funding. The state plan should be consistent with the HHS national plan, and contain measurable 5-year goals and interim milestones for preventing HAIs. “It’s been made clear in the Omnibus Bill that each state must have an HAI plan and that it must cascade down from the HHS plan,” DrWright explained. “Those plans will be graded by HHS and a report sent to Congress by June 2010.”

Future Trends

According to Dr Wright, HHS’s work on HAIs has just begun. “We want to make sure the action plan is implemented in states across the country. And we also believe it’s time to move outside hospitals and into our tier two priorities,” Dr Wright explained.

Those priorities include ambulatory surgical centers and dialysis centers—two major sources of HAIs. There are 4,950 dialysis centers in the United States—a 72% increase since 1996. And there are 5,100 surgical centers—up 240% in that same amount of time. More than 6 million surgeries are performed in ASCs each year. “It’s in these settings that infection control oversight has been lacking and we want to focus on this,” Dr Wright explained.

Common outbreaks in outpatient settings include blood stream infection, contamination in infusion centers, multi-drug resistant organisms, and Hepatitis B and C. In dialysis centers, a high mortality and increasing morbidity from infections, coupled with an emerging pattern of antimicrobial resistance,make those facilitiesofparticular concernin futureHHS efforts.

However, the data is not available to calculate exact numbers for HAIs in these facilities. “Our surveillance system in the ambulatory settings and outpatient facilities are not powerful enough to determine that clearly,” Dr Wright said.

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