CDC Proposal Aims To Save Lives, Money and Decrease Resistance

Improvements in infection control and antibiotic prescribing could save 37,000 lives over five years and billions of dollars in medical care costs, according to a new report from the Centers for Disease Control and Prevention (CDC).

Inappropriate antibiotic use and slack infection control practices have led to the spread of C. difficile and drug-resistant bacteria, such as carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA) and resistant Pseudomonas aeruginosa, throughout health care facilities when patients are transferred from one to another for care. These infections can cause serious health complications, including sepsis or death. Even facilities that follow recommended infection control and antibiotic use practices are at risk when they receive patients who carry these organisms from other health care facilities, according to CDC Director Tom Frieden, MD, MPH. “This is a big problem and it is increasing in the U.S. now, and it is expensive in terms of lives and in terms of costs,” said Dr. Frieden at a press briefing.

“The CDC analysis done in collaboration with the Johns Hopkins Bloomberg School of Public Health, the University of Utah and the University of California, Irvine School of Medicine clearly shows that we could see many fewer antibiotic-resistant infections and much less C. diff if health care facilities and public health staff, public health professionals, work together as a team,” he said.

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The CDC’s mathematical modeling projects increases in drug-resistant infections and C. difficile if there are no immediate, nationwide improvements in infection control and antibiotic prescribing (Vital Signs 2015. [Published online Aug. 4]). However, the model also projects that a coordinated approach—health care facilities and health departments in an area working together—could prevent up to 70% of life-threatening CRE infections over five years. Additional estimates show that national infection control and antibiotic stewardship efforts led by federal agencies, health care facilities and public health departments could prevent 619,000 antibiotic-resistant and C. difficile infections and save 37,000 lives over five years.

Antibiotic-resistant organisms cause more than 2 million illnesses and at least 23,000 deaths each year in the United States, according to the CDC. In 2011, C. difficile caused nearly a half-million illnesses and an estimated 15,000 deaths, the agency said.

The report recommends the following coordinated, two-part approach to prevent infectious illness and save lives:

1. Public health departments should track drug-resistant organism outbreaks in their area and alert health care facilities about them and the threat of organisms coming from other facilities, and
2. Health care facilities should work with one another and with public health authorities to implement shared infection control actions to stop the spread of antibiotic-resistant organisms andC. difficilebetween facilities.

“Effective implementation of the program as we have outlined would prevent more than 600,000 antibiotic-resistant and C. diff infections and save 37,000 lives and $7.7 billion over five years,” said Dr. Frieden. “We can dramatically reduce these infections if health care facilities, nursing homes and public health departments work together to improve antibiotic use and infection control so patients are protected.”

The model shows how coordination could reduce CRE over a five-year period after the drug-resistant bacteria enter 10 facilities in an area that shares patients. For example, no coordination results in 2,000 patients getting CRE, affecting 12% of patients in the area. When a facility acts alone to enhance its infection control practices, the situation improves, resulting in 1,500 patients getting CRE, affecting 8% of patients. But with a coordinated approach, in which facilities work together to prevent infections and notify one another of CRE problems before transferring patients, the model shows far fewer patients at risk: 400 patients predicted to get CRE, affecting only 2%.

“When one facility is preventing infections but a second isn’t, transferring patients can re-infect the facility that was at first clear of infections. Lack of coordination puts patients at higher risk,” Dr. Frieden said. “We need to think in terms of the whole communities. Facilities that go it alone can’t effectively protect their own patients.”

The report also describes the importance of public health departments taking the lead to:

• Identify health care facilities in the area and know how they are connected.
• Dedicate staff to improve connections and coordination with health care facilities in the area.
• Work with CDC to use data for action to prevent infections and improve antibiotic use in health care.
• Know the antibiotic resistance threats in the area and the state.

“We must transform our public health response to turn the tide. The coordinated response this Vital Signs report describes is a forward-looking approach,” said Beth Bell, MD, MPH, director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases. “The president’s FY 2016 budget would accelerate efforts to strengthen our response and improve antibiotic stewardship in health care facilities.”

Health departments must lead the coordination because they can have unique access to data across facility types around their state, Dr. Frieden added. “If you’re a hospital doing a great job but the hospital across town or the doctor down the street is not doing a good job, your patients are at risk.

“Change at the state level is particularly critical,” he said. “Not all health departments will be prepared to take on this coordination and we know that. That’s one reason why we’ve requested funds in the fiscal year [2016] antibiotic solutions initiative to fund state protection programs in all 50 states and 10 large cities to do this work.”

Complementing the public health coordination, the report recommends that hospital owners and health care facility administrators consider steps to:

• Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
• Review and perfect infection control actions in each facility.
• Make leadership commitments to join area health care–associated infection (HAI)/antibiotic resistance prevention activities.
• Connect with public health departments to share data about antibiotic resistance and other HAIs.
• Provide clinical staff access to prompt and accurate laboratory testing for antibiotic-resistant germs.

The CDC data used two mathematical simulation models to estimate the impact of the coordinated approach on preventing the spread of antibiotic-resistant organisms within a group of health care facilities in an area, and data from CDC’s National Healthcare Safety Network and Emerging Infections Program.

 

 

 

Improvements in infection control and antibiotic prescribing could save 37,000 lives over five years and billions of dollars in medical care costs, according to a new report from the Centers for Disease Control and Prevention (CDC).

Inappropriate antibiotic use and slack infection control practices have led to the spread of C. difficile and drug-resistant bacteria, such as carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA) and resistant Pseudomonas aeruginosa, throughout health care facilities when patients are transferred from one to another for care. These infections can cause serious health complications, including sepsis or death. Even facilities that follow recommended infection control and antibiotic use practices are at risk when they receive patients who carry these organisms from other health care facilities, according to CDC Director Tom Frieden, MD, MPH. “This is a big problem and it is increasing in the U.S. now, and it is expensive in terms of lives and in terms of costs,” said Dr. Frieden at a press briefing.

“The CDC analysis done in collaboration with the Johns Hopkins Bloomberg School of Public Health, the University of Utah and the University of California, Irvine School of Medicine clearly shows that we could see many fewer antibiotic-resistant infections and much less C. diff if health care facilities and public health staff, public health professionals, work together as a team,” he said.

ADVERTISEMENT

The CDC’s mathematical modeling projects increases in drug-resistant infections and C. difficile if there are no immediate, nationwide improvements in infection control and antibiotic prescribing (Vital Signs 2015. [Published online Aug. 4]). However, the model also projects that a coordinated approach—health care facilities and health departments in an area working together—could prevent up to 70% of life-threatening CRE infections over five years. Additional estimates show that national infection control and antibiotic stewardship efforts led by federal agencies, health care facilities and public health departments could prevent 619,000 antibiotic-resistant and C. difficile infections and save 37,000 lives over five years.

Antibiotic-resistant organisms cause more than 2 million illnesses and at least 23,000 deaths each year in the United States, according to the CDC. In 2011, C. difficile caused nearly a half-million illnesses and an estimated 15,000 deaths, the agency said.

The report recommends the following coordinated, two-part approach to prevent infectious illness and save lives:

1. Public health departments should track drug-resistant organism outbreaks in their area and alert health care facilities about them and the threat of organisms coming from other facilities, and
2. Health care facilities should work with one another and with public health authorities to implement shared infection control actions to stop the spread of antibiotic-resistant organisms andC. difficilebetween facilities.

“Effective implementation of the program as we have outlined would prevent more than 600,000 antibiotic-resistant and C. diff infections and save 37,000 lives and $7.7 billion over five years,” said Dr. Frieden. “We can dramatically reduce these infections if health care facilities, nursing homes and public health departments work together to improve antibiotic use and infection control so patients are protected.”

The model shows how coordination could reduce CRE over a five-year period after the drug-resistant bacteria enter 10 facilities in an area that shares patients. For example, no coordination results in 2,000 patients getting CRE, affecting 12% of patients in the area. When a facility acts alone to enhance its infection control practices, the situation improves, resulting in 1,500 patients getting CRE, affecting 8% of patients. But with a coordinated approach, in which facilities work together to prevent infections and notify one another of CRE problems before transferring patients, the model shows far fewer patients at risk: 400 patients predicted to get CRE, affecting only 2%.

“When one facility is preventing infections but a second isn’t, transferring patients can re-infect the facility that was at first clear of infections. Lack of coordination puts patients at higher risk,” Dr. Frieden said. “We need to think in terms of the whole communities. Facilities that go it alone can’t effectively protect their own patients.”

The report also describes the importance of public health departments taking the lead to:

• Identify health care facilities in the area and know how they are connected.
• Dedicate staff to improve connections and coordination with health care facilities in the area.
• Work with CDC to use data for action to prevent infections and improve antibiotic use in health care.
• Know the antibiotic resistance threats in the area and the state.

“We must transform our public health response to turn the tide. The coordinated response this Vital Signs report describes is a forward-looking approach,” said Beth Bell, MD, MPH, director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases. “The president’s FY 2016 budget would accelerate efforts to strengthen our response and improve antibiotic stewardship in health care facilities.”

Health departments must lead the coordination because they can have unique access to data across facility types around their state, Dr. Frieden added. “If you’re a hospital doing a great job but the hospital across town or the doctor down the street is not doing a good job, your patients are at risk.

“Change at the state level is particularly critical,” he said. “Not all health departments will be prepared to take on this coordination and we know that. That’s one reason why we’ve requested funds in the fiscal year [2016] antibiotic solutions initiative to fund state protection programs in all 50 states and 10 large cities to do this work.”

Complementing the public health coordination, the report recommends that hospital owners and health care facility administrators consider steps to:

• Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
• Review and perfect infection control actions in each facility.
• Make leadership commitments to join area health care–associated infection (HAI)/antibiotic resistance prevention activities.
• Connect with public health departments to share data about antibiotic resistance and other HAIs.
• Provide clinical staff access to prompt and accurate laboratory testing for antibiotic-resistant germs.

The CDC data used two mathematical simulation models to estimate the impact of the coordinated approach on preventing the spread of antibiotic-resistant organisms within a group of health care facilities in an area, and data from CDC’s National Healthcare Safety Network and Emerging Infections Program.