By Gary Evans, Senior Medical Writer
In a time of political transition and turmoil, the Association for Professionals in Infection Control and Epidemiology (APIC) has issued a Public Policy Agenda1 that clarifies key legislative issues for action and advocacy by infection preventionists. The association also posted a legislative toolkit that walks IPs through the steps to begin state or federal political advocacy.2
While the current political landscape is certainly unpredictable, APIC has several key legislative issues that should have bipartisan appeal. Foremost among these is support of antibiotic stewardship programs to prevent the fading efficacy of drugs against an increasing array of resistant bacterial infections.
CMS is expected to finalize a regulation in 2017 that would make antibiotic stewardship programs a condition of participation in hospitals and other healthcare settings.3 APIC supports the CMS requirements to establish drug stewardship programs, which would include key collaborative roles for IPs. (See the August 2016 of Hospital Infection Control & Prevention for more information.)
The political advocacy document also emphasizes APIC support of resources for CDC surveillance programs for healthcare-associated infections (HAIs).
“[This document reflects] the work that we have done across party lines regarding patient infections and keeping patients safe,” says Susan Dolan, RN, MS, CIC, president of APIC. “The work we have done, specifically in the past decade, has been to educate and influence policymakers in a way to make our voices heard both individually and collectively. I think this document — regardless of which administration is in place — is pretty solid on some important things. Certainly, antimicrobial resistance and emerging infectious diseases should be of concern to anyone.”
Underscoring that healthcare-associated infections kill 75,000 patients a year — a toll comparable to annual fatalities in car wrecks and breast cancer combined — APIC made a strong case for continued political support for IPs and their public health partners. Overall, APIC reminds IPs in the public policy agenda document that they have critical roles in the following healthcare issues:
- developing proven policies to ensure a safe environment for patients,
- ensuring compliance with standards and regulations designed to protect patients and healthcare personnel,
- tracking and monitoring activities to identify and prevent HAIs and other infectious agents,
- leading and participating in healthcare quality improvement efforts designed to protect patients,
- educating the public and healthcare personnel about infectious diseases and how to limit their spread,
- serving as leaders in preparing healthcare facilities and personnel for events such as an influenza pandemic, emerging infectious diseases, and bioterrorism, and
- reporting communicable diseases to the CDC.1
NHSN a High Priority
We asked Dolan, an infection preventionist at Children’s Hospital Colorado in Aurora, to comment further on APIC’s priorities for political and legislative advocacy.
HIC: You traditionally have published these kinds of advocacy positions and statements in separate documents or position papers. Why the compilation?
Dolan: The beauty of this document is that it has a reach beyond just looking at policymakers and infection preventionists, but that is our main target. [We want] to get IPs engaged as members and have a voice. With regard to policymakers, the overarching theme here is really to inform, educate, and influence. I feel like we have used some of these documents individually when we have lobbied with our policymakers and they have been effective in keeping our message clear so that we are all communicating in the same way. With this document, we now have it all in one place and we can continue to grow this document as the [political] landscape changes.
HIC: Are there any issues of particular concern or importance in terms of legislative priorities?
Dolan: The one thing we are watching carefully is anything that could jeopardize funding for key programs that are necessary for infection control. One of them specifically is the CDC’s National Healthcare Safety Network (NHSN) because that really is a program that has expanded out beyond the hospital into the community, long-term care, and across the continuum of care.
We are making great progress with federal partners in working with the measures that are being put in place and making sure that the monetary compensation issues are also tied to those. We are getting into a standardization process that is really starting to give us the platform for moving measures out beyond hospitals. That work is really key. We need continued funding for the NHSN program so that we can continue to do this work for patients -- regardless of what political affiliation they are.
HIC: Antibiotic stewardship has certainly been a bipartisan issue to this point. The CMS is expected to finalize their regulation requiring stewardship programs this year, and APIC takes a positive view of that likelihood in your legislative agenda.
Dolan: Absolutely, yes. It is a critical component having infection preventionists be part of that team. That is something we are advocating for and APIC has had a lot of involvement in this process. We are working with our fellow organization -- SHEA [Society for Healthcare Epidemiology of America] -- to relook at the antimicrobial stewardship paper that we [jointly published in 2012].4 We are revising it this year with updated information, and also to give it a stronger platform for IPs.
Certainly, for our members, we are helping them to understand what their role is in the antibiotic stewardship process — so it is clear to them that this is not really just a physician-driven measure. It really takes infection prevention together with those individuals to make it effective. We are absolutely very involved with our [SHEA colleagues] with that, but we are also educating those on the front lines about the importance of what this means and what their role could be. For example, nurses at the bedside, individuals in the operating room, various places where that education needs to take place. I think one of the big areas that is going to come down the pike is how to effectively do [antibiotic stewardship] in long-term care facilities where resources are limited. What would these [programs] look like in community settings where you don’t have an infectious disease physician? How can they have access to the people who have expertise in this area?
HIC: Just to clarify, are you satisfied with the IP role as outlined in the CMS antibiotic stewardship draft regulation or do you expect further revisions there?
Dolan: I think it is in evolution as we continue to move it forward. Currently, we do feel that IPs have a place [in stewardship programs] and we see the value of that in their work. One of the things that is going to very helpful is to make sure that they have the resources to do some of this work electronically. So, you can actually pull out the reports where there are red flags [for antibiotic misuse] and things can be targeted. That’s where some of these resources can really help IPs on stewardship teams be more effective — rather than doings things manually. To me, it is important to leverage some of the resources that are needed and make sure people in institutions understand that this is not a one-person deal. It’s a team effort.
HIC: We have mainly talked about federal regulations, but of course these same positions and background information could inform IPs with policymaking at the individual state level.
Dolan: Absolutely, and we have had a fairly engaged program within APIC for our local members at the chapter level to have a voice with their state representatives. We have a toolkit that has been put together by a group of infection preventionists. It started with a group of IPs in one state and has been fleshed out so that the toolkit can be used by any chapter member to get a group to go to the state level to educate and inform policymakers and influence some of their decisions.
HIC: OSHA has made several moves in recent years to lay the groundwork for an infectious disease standard to protect healthcare workers. That said, it seems relatively clear that the incoming administration was not elected on the promise of enacting more federal regulation.
Dolan: We are watching to see what is going to happen there — so at the point that [an OSHA] document would come out for comment, we could have a voice and provide feedback through our usual process. It is something that we are aware is in the wings. I would agree with you, we are not quite sure where that will go initially. But it seems that things that fall into that bucket are likely to be delayed.
- APIC. Voice for Infection Prevention: Public Policy Agenda. 2016:
- APIC. Voice for Infection Prevention Advocacy Toolkit: A Guide for Visits with State Legislators. 2016:
- CMS. Medicare and Medicaid Programs; Hospital and Critical Access Hospital (CAH) Changes To Promote Innovation, Flexibility, and Improvement in Patient Care. Proposed Rule. Fed Reg June 16, 2016: http://1.usa.gov/291FtIc.
- Moody J, Cosgrove SE, Olmsted R, et al. Antimicrobial stewardship: A collaborative partnership between infection preventionists and health care epidemiologists Amer J Infect Control 2012;40:94-95.