Monitoring Infections

A similar surveillance gap exists in tracking health care-associated infections (HAIs), which is necessary to monitor the development of antibiotic resistance. Currently, CDC tracks HAIs nationally using the National Health Surveillance Network (NHSN); CDC looks at HAIs in hospitals participating in the NHSN, a voluntary, Internet-based surveillance system and uses them as a cross-section to determine the infection rate nationally.

Those hospitals do not provide an accurate cross-section of the nation, however, GAO investigators said. Facility enrollment in NHSN is either voluntary, required by a state mandate or obligatory as a condition of participation in certain HHS programs.

“This group of facilities is not representative of facilities nationwide, as a random sample would be,” the report states. “Participating healthcare facilities in states with mandated participation are more likely to be overrepresented, while facilities in states without mandates are more likely to be underrepresented.”

To compound that deficiency, data supplied to NHSN by participating hospitals do not fully reflect the scope of HAIs occurring within those facilities. For example, some report central-line associated bloodstream infections but not catheter-associated urinary tract infections. Some hospitals report HAI data for their intensive-care units but not their specialty units. CDC depends on that microbiology data to determine which cases are actually HAIs. If hospitals send only partial data, the final numbers calculated by CDC will be severely handicapped. 

“Without an accurate national estimate of antibiotic-resistant HAIs, CDC cannot assess the magnitude and types of such infections that occur in all patient populations,” the GAO reports states. 

Blind to Antibiotic Disposal

Federal agencies also are failing to collect data on the disposal of antibiotics, even though both the Environmental Protection Agency and the U.S. Geological Survey have measured the presence of certain antibiotics in the environment due, in part, to improper disposal. Studies have shown that antibiotics in the environment can lead to bacterial resistance in humans.

According to the report, EPA tracks the disposal of hazardous waste and has developed a system that tracks it from the time it is produced until the time it is disposed, receiving detailed information from companies producing that waste.

EPA’s mandate does not, however, extend to antibiotics, which do not fall under the definition of hazardous waste. As a result, EPA does not receive information about the disposal of antibiotics.

Every five years, the agency is required to publish a list of unregulated contaminants. The EPA uses this list to help determine which contaminants require regulation, although contaminants may remain on the list for many years before the EPA makes a decision.  Erythromycin is the only antibiotic on the current list, published in 2009. According to EPA officials, they are in the process of determining whether regulation is required on erythromycin.

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