Big business, IC unite to combat resistance

Clout of commerce bolsters infection control

Infection control and big business have forged an unprecedented partnership in New York City, where a consortium of hospitals and industry leaders are joining forces against antibiotic-resistant pathogens.

The New York Antibiotic Resistance Project (NYARP) includes six medical centers that are linking up in a surveillance system for antibiotic-resistant nosocomial pathogens. Project planners are hopeful the consortium's clinical findings will have broad implications for antibiotic use and infection control interventions. As proposed, the project will provide data on such factors as antibiotics administered, resistant infections, movement of patients and pathogens between facilities, and comparisons of infection control interventions at the various facilities. Indeed, the project could lead to some effective clinical interventions that could be used by other facilities in New York City and nationally, says Suzanne Lutwick, RN, MPH, CIC, one of the principals in the project and an ICP and director of organization performance at the Maimonides Hospital in Brooklyn NY.

"I'm very excited about this project," she tells Hospital Infection Control. "It will be a model for other urban areas to use to develop this kind of surveillance system. I hope to bring to my facility the information that we will use to guide decisions at the level of the pharmacy and therapeutics committee. We can use the data we are collecting on antibiotic resistance to eventually make recommendations about what type of antibiotics should be considered and should be restricted."

While the clinical findings may well prove important, the most striking aspect of the project may be the high-profile support it has drawn from the New York City business community. The New York City Partnership and Chamber of Commerce is lending its considerable business clout to the project and is assisting the clinicians in applying for state and federal grants.

"It opens opportunities and avenues that we never even thought about before," says Brian Currie, MD, MPH, one of the principal clinicians in the project and medical center epidemiologist for the Montefiore Medical Center, also in New York City. "It turns out there is a significant representation in industry that is concerned about it as much as we are. There are several grants that we have applied for, but in fact the monies to develop these kind of programs are very limited. The link to industry may be very helpful in the sense of additional support in the future to drive the project."

^{Resistant bugs are bad business}

Contributing factors to the novel partnership include increasing awareness of the problem of antibiotic resistant pathogens and ongoing economic restructuring of a health care industry that is one of the city's most important business sectors, explains Willa Appel, PhD, president of the Policy Center of the NY City Partnership. The 67 hospitals in the city provide 12% of the jobs in the metro area and infuse billions of dollars in revenues into the economy, she notes.

"We are very concerned about health care because [it] is undergoing tremendous transition throughout the country. This is a huge and very critical sector in New York. We became concerned about health care in general, and in exploring that, we began hearing about the problems of drug resistant infection."

The partnership brings a formidable level of business clout to a clinical problem, as its members include some 200 CEOs of major corporations based in New York City.

"These people are employers," Appel says. "They are concerned about employees from a human point of view and also from a business point of view. If people are stuck in hospitals for long periods of time because they have gone in for some surgery and have picked up an infection that can't be treated easily - and therefore they are out of commission for months and months - that's of concern to employers."

The campaign also has public relations aspects as well, underscoring the city's commitment to providing excellent health care. And in drawing attention to the problem, the project raises public awareness of infection control professionals and could empower programs even in facilities not directly participating in the consortium.

"Some of the infection control people and the microbiology people have already thanked the partnership for becoming involved because suddenly their CEO knows they exist," she says. "They are critically important."

By the same token, infection control problems are not typically discussed so openly, and the administrators at the medical facilities should be credited for agreeing to participate, she emphasizes.

"This is not the kind of PR they generally seek," Appel says. "It may be good PR for infection control people, but CEOs don't like talking about a problem, even if it is a universal problem. This is the kind of leadership role that the institutional leaders have taken. It has required some guts, and I think that it deserves a great deal of credit."

^{Corporate sponsors possible}

While the consortium is applying for state and federal grants, Appel does not rule out the possibility of corporate sponsorships for the project.

"We are just proceeding on the assumption that we are going to raise the money," she says. "Just to get the [computer] software worked on the first couple of years is several hundred thousand dollars."

Indeed, the surveillance system used by the medical settings will allow compilation of an aggregate database that will glean pertinent information from pharmacy, microbiology, and patient billing records, Currie explains. Thus clinicians can determine, for example, which antibiotics a patient was administered prior to developing an infection with a drug resistant pathogen.

"There are a variety of risk factors you can look at besides prior antibiotic history." he says. "We also are assessing infection control and antibiotic control initiatives at each one of the participating hospitals - and compliance with those programs."

The names of all six medical centers involved in the project have not been released, but they comprise a total of nine hospitals, over 6,000 hospital beds and 270,000 annual patient discharges. There are also about 650 intensive care unit beds at the participating centers, as well as other high-risk environments like oncology units, neonatal nurseries and burn units, Currie notes.

"Our intent is to devise programs that can be generalized to other institutions," he says. "We're talking about a hospital sample size of between roughly 200 beds, to 1500 beds and developing programs that are functional and proven to be effective in a variety of settings."

As proposed, the project will collect lab results from patient blood cultures to identify and track such pathogens as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Indeed, pathogens like VRE began causing problems in New York City long before they appeared in other U.S. medical settings, he noted.

"Some of the first VRE isolates in the United States were recorded were in New York City," he says. "Since that first reporting, within three years they were found in every hospital in New York City, and they have virtually spread across the country."

Such findings are not surprising, given the demographics of a large patient population and close proximity of many medical centers.

"There are 67 acute care hospitals in the five boroughs of the city," he says. "That is a tremendous concentration of hospital beds, antibiotic use, and movement of patients over limited geographic area."