Healthcare-associated infections: what can be done to reduce risk to our patients?

VOLUME 93 NO. 9 SEMPTEMBER 2010 Approximately two million patients develop a hospital-acquired infection each year in the USA, contributing to approximately 100,000 deaths. To put this into perspective, there are an estimated 70,000 deaths in the US each year due to accidents of all causes. Thus, hospital-acquired infections are one of the leading causes of death in the US. Until recently, there was little in the public domain regarding the scope of the problem and a limited amount of federal funding to improve our understanding of why such infections occur and how to prevent them. Nevertheless, most states, including Rhode Island, now mandate public reporting of hospital-acquired infections (http:// www.apic.org/scriptcontent/custom/ dyncontent/legislation/index.cfm? section=government_advocacy). In October 2008, the Centers & Medicare and Medicaid Services (CMS) started a program of non-payment for some hospital-acquired infections, and some non-federal insurance plans are following suit. Yet hospitals have not felt the full impact of this intervention, in part due to inaccurate ICD-9 coding for hospital-acquired infections. Today, an ever increasing number of hospital-acquired infections are caused by multi-drug resistant microbes. Some of these pathogens are resistant to most, if not all, FDA-approved antibiotics. In this era of Andromeda strains of microbial pathogens, prevention of hospital-acquired infections is of paramount importance. There is convincing evidence that hospitalwide, statewide, and national coordinated efforts implementing evidencebased infection control initiatives can reduce the risk of hospital-acquired infections. Most hospital epidemiologists know what to do to mitigate risk. The challenge remains to do the job in the current economic climate with competing priorities and limited dollars. Healthcare-Associated Infections: What Can Be Done To Reduce Risk To Our Patients?