Feedback for the future: ICPs polled on CDC goals

Hercules had his 12 labors, and seemingly as difficult are the seven infection challenges that have been established by the Centers for Disease Control and Prevention division of healthcare quality promotion.

Julie Gerberding, MD, MPH, director of the CDC division, reviewed the seven challenges recently in Seattle at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC). The goals, to be accomplished over the next five years in U.S. health care settings, are:

• Reduce targeted catheter-associated adverse events by 50%.

• Reduce targeted surgical adverse events by 50%.

• Reduce targeted antimicrobial-resistant bacterial infections by 50% by optimizing antimicrobial use and preventing transmission in health care settings.

• Reduce mortality and hospital admissions associated with respiratory infections by 50% in long-term care facilities.

• Eliminate microbiology laboratory errors (e.g., misidentification of patient, wrong susceptibility tests performed).

• Eliminate the adverse consequences of occupational injuries, including needlesticks, infections and the need for post-exposure prophylaxis.

• Achieve 100% compliance with the CDC Advisory Committee on Immunization Practices for immunization of health care workers.

"These are, for us, lofty challenges," Gerberding told APIC attendees. "We cannot do this in Atlanta. We cannot do it in Washington. We can’t do this at the state capital. We can’t do this at APIC. This kind of process has to be initiated at the local level — at the sharp edge of the health care delivery system. In order for us to be successful, we need to engage our partners, the experts who know how to get things done."

In that regard, the CDC surveyed APIC members about the feasibility of the challenges, drawing both creative suggestions and real-world assessments. "There was recognition that if you want to reduce catheter infections by 50%, reduce catheter days by 50% and you will have accomplished your task," she noted, citing the common-sense advice of ICPs.

The CDC polled APIC chapter members in 40 states, drawing responses and suggestions that are expected to be detailed more fully in the future.

"By working with APIC to get this kind of input, we were, in fact, advertising the challenges and making it clear to people that we were serious about what we were doing and we truly needed their help," she told conference attendees.

While staffing emerged as the primary obstacle, suggestions to accomplish the goals included standardizing equipment and methods across a health care system, emphasizing professional credentials and competency, and creating teams to focus on areas such as inserting intravenous lines and administering preoperative antibiotic prophylaxis. Regarding antibiotic resistance, ICPs called for more collaboration with pharmacy staff and creating antibiogram profiles for specific patient populations. Communication links across the continuum were a common theme, as shared information is critical to preventing adverse patient outcomes.

"Wouldn’t we love that [data] for surveillance purposes, and also to extend that into physicians’ offices," Gerberding said. "The technology to do that exists today. This is no longer rocket science. But it is a systems problem that we haven’t figured out how to go about using the technology that we already have."

There were suggestions to reward infection control policy adherence, but also some calls to force the hand of health care workers reluctant to take vaccines. "There was interest in lobbying [the Centers for Medicare and Medicaid Services, formerly the Health Care Financing Administration] for including health care immunizations as a patient safety issue," she said.

"If you make an argument that it is bad for patients to have health care workers bringing their vaccine-preventable diseases to work, you could get some regulatory authority and perhaps some better reimbursement for those services."