Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-17T23:14:29.325Z Has data issue: false hasContentIssue false

The Evolving Landscape of Healthcare-Associated Infections: Recent Advances in Prevention and a Road Map for Research

Published online by Cambridge University Press:  10 May 2016

Nasia Safdar*
Affiliation:
University of Wisconsin, Madison, Infectious Disease Division, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
Deverick J. Anderson
Affiliation:
Duke University Medical Center, Department of Infectious Diseases, Durham, North Carolina
Barbara I. Braun
Affiliation:
The Joint Commission, Oakbrook Terrace, Illinois
Philip Carling
Affiliation:
Boston University School of Medicine, Boston, Massachusetts
Stuart Cohen
Affiliation:
Division of Infectious Diseases, University of California Davis School of Medicine, Hospital Epidemiology and Infection Prevention, Sacramento, California
Curtis Donskey
Affiliation:
Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Marci Drees
Affiliation:
Christiana Care Health System, Newark, Delaware
Anthony Harris
Affiliation:
University of Maryland School of Medicine, EPH Genomic Epidemiology & Clinical Outcomes, Baltimore, Maryland
David K. Henderson
Affiliation:
National Institutes of Health Clinical Center, Bethesda, Maryland
Susan S. Huang
Affiliation:
University of California Irvine School of Medicine, Irvine, California
Manisha Juthani-Mehta
Affiliation:
Yale University School of Medicine, Section of Infectious Diseases, New Haven, Connecticut
Ebbing Lautenbach
Affiliation:
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Darren R. Linkin
Affiliation:
University of Pennsylvania, Philadelphia, Pennsylvania
Jennifer Meddings
Affiliation:
University of Michigan, Ann Arbor, Michigan
Loren G. Miller
Affiliation:
Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, California
Aaron Milstone
Affiliation:
Johns Hopkins University, Baltimore, Maryland
Daniel Morgan
Affiliation:
University of Maryland School of Medicine and Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
Sharmila Sengupta
Affiliation:
Department of Microbiology, BLK Super Specialty Hospital, Delhi, India
Meera Varman
Affiliation:
Creighton University Medical Center, Omaha, Nebraska
Deborah Yokoe
Affiliation:
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Danielle M. Zerr
Affiliation:
Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, Washington
*
600 Highland Avenue, H4/574, Madison, WI 53792 (ns2@medicine.wisc.edu)

Abstract

This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, “Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA,” which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.

Type
SHEA White Paper
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Research Committee of the Society of Healthcare Epidemiology of America. Enhancing patient safety by reducing healthcare-associated infections: the role of discovery and dissemination. Infect Control Hosp Epidemiol 2010;31:118123.Google Scholar
2. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl I Med 2006;355:27252732.Google Scholar
3. Affordable Care Act S. Payment Adjustment for Conditions Acquired in Hospitals No. 111-148, 124 Stat Available, http://www.gpo.gov/fdsys/pkg/PLAW-11 lpubll48/pdf/PLAW-lllpubll48.pdf. Accessed July 10, 2012.Google Scholar
4. Department of Health and Human Services. Department of Health and Human Services Action Plan to Prevent Healthcare-Associated Infections 2012. http://www.hhs.gov/ash/initiatives/hai/actionplan/hhs_hai_action_plan_final_06222009.pdf. 2009. Accessed March 12, 2014. Google Scholar
5. Centers for Medicare and Medicaid Services. H. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long term care hospital prospective payment system and proposed fiscal year 2014 rates. Federal Register 2013;78:2762227635.Google Scholar
6. Fakih, MG, Greene, MT, Kennedy, EH, et al. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012;40:359364.Google Scholar
7. Saint, S, Olmsted, RN, Fakih, MG, et al. Translating health care-associated urinary tract infection prevention research into practice via the bladder bundle. Jt Comm J Qual Patient Saf 2009;35:449455.Google ScholarPubMed
8. Lee, GM, Hartmann, CW, Graham, D, et al. Perceived impact of the Medicare policy to adjust payment for health care-associated infections. Am J Infect Control 2012;40:314319.Google Scholar
9. Lee, GM, Kleinman, K, Soumerai, SB, et al. Effect of nonpayment for preventable infections in U.S. hospitals. N Engl J Med 2012;367:14281437.CrossRefGoogle ScholarPubMed
10. Mu, Y, Edwards, JR, Horan, TC, Berrios-Torres, SI, Fridkin, SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011;32:970986.Google Scholar
11. Klompas, M. Advancing the science of ventilator-associated pneumonia surveillance. Crit Care 2012;16:165.CrossRefGoogle ScholarPubMed
12. Centers for Disease Control and Prevention (CDC). 2013. CDC/National Healthcare Safety Network Surveillance Definitions for Specific Types of Infections, http://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. Accessed March 12, 2014.Google Scholar
13. Stone, ND, Ashraf, MS, Calder, J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012;33:965977.Google Scholar
14. Klompas, M. Prevention of ventilator-associated pneumonia. Expert Rev Anti Infect Ther 2010;8:791800.CrossRefGoogle ScholarPubMed
15. Klompas, M. Interobserver variability in ventilator-associated pneumonia surveillance. Am J Infect Control 2010;38:237239.Google Scholar
16. Bekaert, M, Timsit, JF, Vansteelandt, S, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med 2011;184:11331139.Google Scholar
17. Cook, D, Guyatt, G, Marshall, J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med 1998;338:791797.Google Scholar
18. Oostdijk, EA, de Smet, AM, Kesecioglu, J, Bonten, MJ; Dutch SOD-SDD Trialists Group. The role of intestinal colonization with gram-negative bacteria as a source for intensive care unit-acquired bacteremia. Crit Care Med 2011;39:961966.CrossRefGoogle ScholarPubMed
19. Thompson, ND, Yeh, LL, Magill, SS, Ostroff, SM, Fridkin, SK. Investigating systematic misclassification of central line-associated bloodstream infection (CLABSI) to secondary bloodstream infection during health care-associated infection reporting. Am J Med Qual 2013;28:5659.Google Scholar
20. Clancy, CM. Getting to zero: our effort to eliminate infections nationwide. J Nurs Care Qual 2010;25:189192.Google Scholar
21. Clancy, CM. Getting to zero: new resources aim to reduce health care-associated infections. Am J Med Qual 2010;25:319321.Google Scholar
22. Edmond, MB. Getting to zero: is it safe? Infect Control Hosp Epidemiol 2009;30:7476.Google Scholar
23. Kaufman, DA. “Getting to Zero”: preventing invasive Candida infections and eliminating infection-related mortality and morbidity in extremely preterm infants. Early Hum Dev 2012;88: S45S49.CrossRefGoogle ScholarPubMed
24. Richards, C. Getting to zero: an emerging policy framework for the elimination of hospital-associated infections. Infect Control Hosp Epidemiol 2009;30:7173.Google Scholar
25. Anderson, DJ, Kaye, KS, Classen, D, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29:S51S61.Google Scholar
26. Bolon, MK, Hooper, D, Stevenson, KB, et al. Improved surveillance for surgical site infections after orthopedic implantation procedures: extending applications for automated data. Clin Infect Dis 2009;48:12231229.Google Scholar
27. Yokoe, DS, Shapiro, M, Simchen, E, Platt, R. Use of antibiotic exposure to detect postoperative infections, infect Control Hosp Epidemiol 1998;19:317322.CrossRefGoogle ScholarPubMed
28. Calderwood, MS, Ma, A, Khan, YM, et al. Use of Medicare diagnosis and procedure codes to improve detection of surgical site infections following hip arthroplasty, knee arthroplasty, and vascular surgery. Infect Control Hosp Epidemiol 2012;33:4049.Google Scholar
29. Huang, SS, Placzek, H, Livingston, J, et al. Use of Medicare claims to rank hospitals by surgical site infection risk following coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2011;32:775783.Google Scholar
30. Olsen, MA, Fraser, VJ. Use of diagnosis codes and/or wound culture results for surveillance of surgical site infection after mastectomy and breast reconstruction. Infect Control Hosp Epidemiol 2010;31:544547.CrossRefGoogle ScholarPubMed
31. Platt, R, Yokoe, DS, Sands, KE. Automated methods for surveillance of surgical site infections. Emerg Infect Dis 2001;7:212216.Google Scholar
32. Moehring, RW, Anderson, DJ. “But my patients are different!”: risk adjustment in 2012 and beyond. Infect Control Hosp Epidemiol 2011;32:987989.Google Scholar
33. Won, SY, Munoz-Price, LS, Lolans, K, et al. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2011;53:532540.Google Scholar
34. Lin, MY, Lyles-Banks, RD, Lolans, K, et al. The importance of long-term acute care hospitals in the regional epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Clin Infect Dis 2013;57:12461252.Google Scholar
35. O'Fallon, E, Kandel, R, Schreiber, R, D'Agata, EM. Acquisition of multidrug-resistant gram-negative bacteria: incidence and risk factors within a long-term care population. Infect Control Hosp Epidemiol 2010;31:11481153.Google Scholar
36. Centers for Disease Control and Prevention. Vital signs: preventing Clostridium difficile infections. MMWR. Morb Mortal Wkly Rep 2012;61:157162.Google Scholar
37. Juthani-Mehta, M, Quagliarello, VJ. Infectious diseases in the nursing home setting: challenges and opportunities for clinical investigation. Clin Infect Dis 2010;51:931936.CrossRefGoogle ScholarPubMed
38. Thorn, KA, Maragakis, LL, Richards, K, et al. Assessing the burden of Acinetobacter baumannii in Maryland: a statewide cross-sectional period prevalence survey. Infect Control Hosp Epidemiol 2012;33:883888.CrossRefGoogle Scholar
39. Centers for Disease Control and Prevention. Vital signs: car-bapenem-resistant Enterobacteriaceae. MMWR Morb Mortal Wkly Rep 2013;62:165170.Google Scholar
40. Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27:920925.Google Scholar
41. Furuno, JP, Schweizer, ML, McGregor, JC, Perencevich, EN. Economics of infection control surveillance technology: cost-effective or just cost? Am J Infect Control 2008;36:S12S17.Google Scholar
42. McDonald, LC, Arduino, M. Editorial commentary: climbing the evidentiary hierarchy for environmental infection control. Clin Infect Dis 2013;56:3639.Google Scholar
43. Carling, PC, Huang, SS. Improving healthcare environmental cleaning and disinfection: current and evolving issues. Infect Control Hosp Epidemiol 2013;34:507513.CrossRefGoogle ScholarPubMed
44. Boyce, JM. Measuring healthcare worker hand hygiene activity: current practices and emerging technologies. Infect Control Hosp Epidemiol 2011;32:10161028.CrossRefGoogle ScholarPubMed
45. Morgan, DJ, Pineles, L, Shardell, M, et al. Automated hand hygiene count devices may better measure compliance than human observation. Am J Infect Control 2012;40:955959.CrossRefGoogle ScholarPubMed
46. Meddings, J, Rogers, MA, Macy, M, Saint, S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51:550560.Google Scholar
47. Milstone, AM, Elward, A, Song, X, et al. Daily Chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial. Lancet 2013;381:10991106.Google Scholar
48. Sammons, JS, Toltzis, P, Zaoutis, TE. Clostridium difficile infection in children. JAMA Pediatr 2013;167:567573.Google Scholar
49. Salgado, CD, Giannetta, ET, Hayden, FG, Farr, BM. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 2004;25:923928.Google Scholar
50. Lemaitre, M, Meret, T, Rothan-Tondeur, M, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 2009;57:15801586.Google Scholar
51. Shugarman, LR, Hales, C, Setodji, CM, Bardenheier, B, Lynn, J. The influence of staff and resident immunization rates on influenza-like illness outbreaks in nursing homes. J Am Med Dir Assoc 2006;7:562567.Google Scholar
52. Talbot, TR, Babcock, H, Caplan, AL, et al. Revised SHEA position paper: influenza vaccination of healthcare personnel. Infect Control Hosp Epidemiol 2010;31:987995.Google Scholar
53. Miller, BL, Ahmed, F, Lindley, MC, Wortley, PM. Institutional requirements for influenza vaccination of healthcare personnel: results from a nationally representative survey of acute care hospitals-United States, 2011. Clin Infect Dis 2011;53:10511059.Google Scholar
54. Centers for Disease Control and Prevention. Pertussis epidemic–Washington, 2012. MMWR Morb Mortal Wkly Rep 2012;61:517522.Google Scholar
55. Centers for Disease Control and Prevention. Pertussis (whooping cough). 2013. http://www.cdc.gov/pertussis/surv-reporting.html. Accessed March 12, 2014.Google Scholar
56. Goins, WP, Schaffner, W, Edwards, KM, Talbot, TR. Healthcare workers' knowledge and attitudes about pertussis and pertussis vaccination. Infect Control Hosp Epidemiol 2007;28:12841289.Google Scholar
57. Platt, R, Takvorian, SU, Septimus, E, et al. Cluster randomized trials in comparative effectiveness research: randomizing hospitals to test methods for prevention of healthcare-associated infections. Med Care 2010;48:S52S57.Google Scholar
58. Morgan, DJ, Meddings, J, Saint, S, et al. Does nonpayment for hospital-acquired catheter-associated urinary tract infections lead to overtesting and increased antimicrobial prescribing? Clin Infect Dis 2012;55:923929.CrossRefGoogle ScholarPubMed
59. Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:15711580.Google Scholar
60. Rosenthal, VD, Maki, DG, Salomao, R, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145:582591.CrossRefGoogle ScholarPubMed
61. Rice, LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis 2008;197: 10791081.Google Scholar
62. Rice, LB. Do we really need new anti-infective drugs? Curr Opin Pharmacol 2003;3:459463.CrossRefGoogle ScholarPubMed
63. Kwon, S, Schweizer, ML, Perencevich, EN. National Institute of Allergy and Infectious Disease (NIAID) Funding for Studies of Hospital-Associated Bacterial Pathogens: Are Funds Proportionate to Burden of Disease? Antimicrob Resist Infect Control 2012;1:5.Google Scholar
64. Klompas, M, Kleinman, K, Platt, R. Development of an algorithm for surveillance of ventilator-associated pneumonia with electronic data and comparison of algorithm results with clinician diagnoses. Infect Control Hosp Epidemiol 2008;29:3137.Google Scholar
65. Sexton, DJ, Chen, LF, Anderson, DJ. Current definitions of central line-associated bloodstream infection: is the emperor wearing clothes? Infect Control Hosp Epidemiol 2010;31:12861289.Google Scholar
66. Bode, LG, Kluytmans, JA, Wertheim, HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362:917.CrossRefGoogle ScholarPubMed
67. Bennett-Guerrero, E, Pappas, TN, Koltun, WA, et al. Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med 2010;363:10381049.Google Scholar
68. Bennett-Guerrero, E, Ferguson, TB Jr, Lin, M, et al. Effect of an implantable gentamicin-collagen sponge on sternal wound infections following cardiac surgery: a randomized trial. JAMA A2010;304 755762.CrossRefGoogle Scholar
69. Derde, LP, Cooper, BS, Goossens, H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 2014;14:31–9.Google Scholar
70. Huskins, WC, Huckabee, CM, O'Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;1407-1418.Google Scholar
71. Loeb, M, Dafoe, N, Mahony, J, et al. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA 2009;302:18651871.Google Scholar
72. Darouiche, RO, Wall, MJ Jr, Itani, KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362:1826.Google Scholar
73. Timsit, JF, Schwebel, C, Bouadma, L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 2009;301:12311241.Google Scholar
74. Timsit, JF, Mimoz, O, Mourvillier, B, et al. Randomized controlled trial of Chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Resp Crit Care Med 2012;186:12721278.Google Scholar
75. de Smet, AM, Kluytmans, JA, Blok, HE, et al. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study. Lancet Infect Dis 2011;11:372380.Google Scholar
76. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily Chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533542.Google Scholar
77. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:22552265.Google Scholar
78. Pickard, R, Lam, T, MacLennan, G, et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomised controlled trial. Lancer 2012;380 19271935.Google Scholar