challenges for infection prevention in the 21 st century william a. rutala, ph.d., m.p.h. unc health...

Challenges for Infection Prevention in the 21st Century

William A. Rutala, Ph.D., M.P.H.UNC Health Care and UNC School of Medicine,

Chapel Hill, NC

Disclosure

This educational activity is brought to you, in part, by Advanced Sterilization Products (ASP) and Ethicon. The speaker receives an honorarium from ASP and Ethicon and must present information in compliance with FDA requirements applicable to ASP.

CHALLENGES IN THE PREVENTION AND MANAGEMENT OF HEALTHCARE-ASSOCIATED INFECTIONS

Changing population of hospital patients Increased severity of illness Increased numbers of immunocompromised patients Shorter duration of hospitalization More and larger intensive care units Larger step-down units

Growing frequency of antimicrobial-resistant pathogens Lack of compliance with hand hygiene and other

infection preventive measures (e.g., endoscope)


Limited infection prevention resources Implementation of bundles demonstrated to reduce HAIs Public reporting of HAIs CMS non-reimbursement for HAIs Health insurance reimbursement tied to quality goals State and federal laws legislating care issues

Influenza immunization for staff MRSA screening of patients and staff

Greater emphasis on infection prevention by The Joint Commission

HEALTHCARE SYSTEM OF THE PAST

Tranquil GardensNursing Home

HomeCare

Acute CareFacility

Outpatient/Ambulatory

Facility

Long Term CareFacility

CURRENT HEALTHCARE SYSTEM

Tranquil GardensNursing Home

HomeCare

Acute CareFacility

Outpatient/Ambulatory

Facility

Long Term CareFacility

HEALTHCARE-ASSOCIATED INFECTIONS: IMPACT

1.7 million infections per year 98,987 deaths due to HAI

Pneumonia 35,967 Bloodstream 30,665 Urinary tract 13,088 SSI 8,205 Other 11,062

6th leading cause of death (after heart disease, cancer, stroke, chronic lower respiratory diseases, and accidents)1

1 National Center for Health Statistics, 2004

MORTALITY RATE OF COMMON HAIs

30.1%

17.7%

5.7%

0.8% 0.7%

Pneumonia BloodstreamInfections

Urinary TractInfections

Surgical SiteInfections

No Infections

INCREMENTAL HOSPITAL DAYSDUE TO COMMON INFECTIONS

Days, 13Days, 14

Days, 4

Days, 7

Pneumonia BloodstreamInfections

Urinary TractInfections

Surgical SiteInfectins

RATES OF HEALTHCARE-ASSOCIATED INFECTIONS PER 1,000 PATIENT DAYS

7.2

9.8

12.2

02468

101214

1975 1985 2005

69% Increase

COST ESTIMATES FOR HEALTHCARE-ASSOCIATED INFECTIONS (HAIs)

HAI Cost per HAI + SE Range

Ventilator-associated pneumonia 25,072 + 4,132 8,682-31,316

Healthcare-associated bloodstream infections

23,242 + 5,184 6,908-37,260

Surgical site infections 10,443 + 3,249 2,527-29,367

Catheter-associated urinary tract infections

758 + 41 728-810

Anderson DJ, et al. ICHE 2007;28:767-773Costs based on literature review 1985-2005; adjusted to US 1995 dollars

HAZARDS IN THE ICU

Weinstein RA. Am J Med 1991;91(suppl 3B):180S

PREVALENCE: ICU (EUROPE)

Study design: Point prevalence rate 17 countries, 1447 ICUs, 10,038 patients

Frequency of infections: 4,501 (44.8%) Community-acquired: 1,876 (13.7%) Hospital-acquired: 975 (9.7%) ICU-acquired: 2,064 (20.6%)

Pneumonia: 967 (46.9%) Other lower respiratory tract: 368 (17.8%) Urinary tract: 363 (17.6%) Bloodstream: 247 (12.0%)

Vincent J-L, et al. JAMA 1995;274:639

RISK FACTORS FOR ICU-ACQUIRED INFECTIONS

0 0.5 1 1.5 2 2.5

Trauma on Admission

Mechanical Ventilation

Urinary Catherization

Stress Ulcer Prophylaxis

CVP Line

PA Catherization

Odds Ratio

(1.01-1.43)

(1.16-1.57)

(1.20-1.60)

(1.19-1.69)

(1.51-2.03)

(1.75-2.44)

(95% CI)

RISK FACTORS FOR ICU-ACQUIRED INFECTIONS

0 10 20 30 40 50 60 70 80

>21

14-20

7-13

5-6

3-4

1-2

Leng

th o

f Sta

y, d

Odds Ratio

(1.56-4.13)

(5.51-14.70)

(9.33-24.14)

(19.43-48.67)

(37.90-96.25)

(48.18-120.06)

(95% CI)

NOSOCOMIAL INFECTIONS IN THE UNITED STATES

Variable 1975 1995Admissions 37,700,000 35,900,000Patient-days 299,000,000 190,000,000Average length of stay 7.9 5.3Inpatient surgical procedures 18,300,000 13,300,000Nosocomial infections 2,100,000 1,900,000Incidence of nosocomial infections (number per 1000 patient-days)

7.2 9.8

Burke JP. NEJM 2003;348:651

AGING POPULATION, US

CANCER: INCIDENCE & DEATHS, 2006 (estimated)

Cancer New Cases Deaths Oral cavity & pharynx 30,990 7,430 Digestive sysetm 263,060 136,180 Respiratory system 186,370 167,050 Skin 68,780 10,710 Breast 214,640 41,430 Genital system 321,490 56,060 Urinary system 102,490 26,670 Leukemia/multiple myeloma 35,070 22,280 Lymphoma 66,670 20,330 TOTAL 1,399,790 564,830

AmericanCancerSociety



Growing frequency of antimicrobial-resistant pathogens and emerging pathogen

Lack of compliance with hand hygiene and other infection preventive measures (e.g., endoscope)

Evolution of Antimicrobial Resistancein Gram-positive Cocci

S. aureusS. aureus

Penicillin

[1940s] Penicillin-resistantS. aureus

Methicillin

[1960s] Methicillin-resistantS. aureus (MRSA)

Vancomycin-resistantVancomycin-resistantenterococcus (VRE)enterococcus (VRE)

VancomycinVancomycin[1997][1997]

Vancomycin(glycopeptide)

intermediate-resistantS. aureus

Vancomycin-resistantS. aureus

CiprofloxacinCiprofloxacin19871987

[2002][2002]

CA-MRSA

UNITED STATES

Enterobacter / Ceftazidime 21→19% E. coli / ESBL phenotype 3→5% E. coli / Ciprofloxacin 4→19% Klebsiella / ESBL phenotype 6→15% Klebsiella / Ciprofloxacin 4→13% Klebsiella / Imipenem (2 μg/ml) <1→5 (3.7)%

UNITED STATES

P. aeruginosa / Imipenem 9→8% P. aeruginosa / Piperacillin-tazobactam 11→12% P. aeruginosa / Ciprofloxacin 17→19% Acinetobacter / Amikacin 11→16% Acinetobacter / Ceftazidime 23→45% Acinetobacter / Imipenem 3→7%

EMERGING INFECTIOUS AGENTS

Current concerns Vancomycin resistant

Staphylococcus aureus Multidrug resistant gram

negative pathogens Clostridium difficile (strains

that hyperproduce toxin) Norovirus Prions XDR-TB

Future concerns but planning required Influenza pandemic

(H5N1?) Bioterrorism Gene transfer Xenotransplantation

EMERGING INFECTIOUS DISEASES RELEVANT TO THE HOSPITAL

1977 (US) – Legionnaire’s disease 1978 (US) – Staphylococcal toxic shock syndrome 1996 (England US) – Variant Creutzfeld-Jakob disease (vCJD) 2001 (US) - Anthrax (attack via letters)* 2002 (US) – Vancomycin-resistant S. aureus* 2002 (Canada US) – Hypervirulent C. difficile* 2003 (China worldwide) - SARS* 2003 (US) – Monkeypox* 2004 (Asia) – Avian influenza (H5N1)* 2006 (Worldwide) – XDR-TB* * HCWs at risk for infection

RISKS FROM EMERGINGINFECTIOIUS DISEASES

Person-to-person transmission Andes hanta virus Anthrax* C. difficile Monkeypox Norovirus (G-II strain) Plague* Rabies Smallpox* Viral hemorrhagic fever*

Fomite transmission Anthrax* C. difficile Norovirus Plague* Q fever* Smallpox*

Lab risk Q fever* Monkeypox Smallpox*

* BT agent

Total SARS Cases and % Healthcare Workers by Country

0

1000

2000

3000

4000

5000

6000

China Hong Kong Taiwan Canada Singapore Vietnam

0

20

40

60

80

100

To

tal N

o. S

AR

S C

ase

s

% HCW

% H

CW

Lack of Compliance

Hand Hygiene Endoscope reprocessing SSI

ASSOCIATION BETWEEN HAND HYGIENE COMPLIANCE AND HAI RATES

Author, year Setting ResultsCasewell, 1977 Adult 1CU Reduction HAI due to Klebsiella

Maki, 1982 Adult 1CU Reduction HAI ratesMassanari, 1984 Adult 1CU Reduction HAI ratesKohen, 1990 Adult 1CU Trend to improvementDoebbeling, 1992 Adult 1CU Different rates of HAI between 2 agentsWebster, 1994 NICU Elimination of MRSA*Zafar, 1995 Newborn Elimination of MRSA*Larson, 2000 MICU/NICU 85% reduction VREPittet, 2000 Hospitalwide Reduction HAI & MRSA cross-transmission

HAI, healthcare-associated infections *Other infection control measures also instituted Boyce JM, Pitter D. MMWR 2002;51(RR-16)

How Is Our Track Record on Handwashingin Healthcare Facilities?

A review of 34 published studies of handwashing adherence among healthcare workers found that adherence rates varied from

5% to 81%

The average adherence rate was only 40%

0102030405060708090

1 4 7 10 13 16 19 22 25 28 31 34

Study

Per

cen

t A

dh

eren

ce

Average Handwashing Adherenceof Personnel in 34 Studies

Average

Hand Hygiene Adherence an Institutional Priority

Multidisciplinary Program Administrative support (IOC, Executive Staff, Dept Heads) Monitor HCWs adherence to policy and provide staff with

information about performance Provide HCWs with accessible hand hygiene (HH) products

to include alcohol based hand rubs Education regarding types of activities that result in hand

contamination and indications for hand hygiene Reminders in the workplace (e.g., posters) Considering ways to include HH in management standards (loss

of hospital privileges, tickets for non-compliance, coffee coupons)

UNC Hospitals Intensive Care Units Hand Hygiene Compliance

0

10

20

30

40

50

60

70

80

90

100

Co

mp

lian

ce (

%)

Leadership presentationsCollected baseline data

Began quarterly compliancereports to ICUsOngoing education

Evaluated hand hygiene products

Staff HH complianceadded to patient satisfaction survey

Pocket-sized alcoholbased gel available

ImplementedInfection ControlLiaisons

GI ENDOSCOPES

Widely used diagnostic and therapeutic procedure Endoscope contamination during use (109 in/105 out) Semicritical items require high-level disinfection minimally Inappropriate cleaning and disinfection has lead to cross-

transmission In the inanimate environment, although the incidence

remains very low (35 cases of transmission from 1993-2002), endoscopes represent a risk of disease transmission

Endoscope Reprocessing: Current Status of Cleaning and Disinfection

Guidelines Society of Gastroenterology Nurses and Associates, 2000 European Society of Gastrointestinal Endoscopy, 2000 British Society of Gastroenterology Endoscopy, 1998 Gastroenterological Society of Australia, 1999 Gastroenterological Nurses Society of Australia, 1999 American Society for Gastrointestinal Endoscopy, 2003 Association for Professional in Infection Control and Epidemiology,

2000 Multi-society Guideline for Reprocessing Flexible GI Endoscopes,

2003 Centers for Disease Control and Prevention, 2004 (in press)

Endoscope Reprocessing, Worldwide

Worldwide, endoscopy reprocessing varies greatly India, of 133 endoscopy centers, only 1/3 performed even

a minimum disinfection (1% glut for 2 min) Brazil, “a high standard …occur only exceptionally” Western Europe, >30% did not adequately disinfect Japan, found “exceedingly poor” disinfection protocols US, 25% of endoscopes revealed >100,000 bacteriaSchembre DB. Gastroint Endoscopy 2000;10:215

TRANSMISSION OF INFECTION

Gastrointestinal endoscopy >300 infections transmitted 70% agents Salmonella sp. and P. aeruginosa Clinical spectrum ranged from colonization to death (~4%) Number of reported infections is small, suggesting a very low

incidence Endemic transmission may go unrecognized

Bronchoscopy 90 infections transmitted M. tuberculosis, atypical Mycobacteria, P. aeruginosa Spach DH et al Ann Intern Med 1993: 118:117-128 and Weber DJ et al Gastroint Dis 2002;87

ENDOSCOPE INFECTIONS

Infections traced to deficient practices Inadequate cleaning (clean all channels) Inappropriate/ineffective disinfection (time exposure,

perfuse channels, test concentration) Failure to follow recommended disinfection practices

(drying, contaminated water bottles, irrigating solutions)

Flaws in design/manufacture of endoscopes or AERs

ENDOSCOPE DISINFECTION

CLEAN-mechanically cleaned with water and enzymatic detergent

HLD/STERILIZE-immerse scope and perfuse HLD/sterilant through all channels for at least 12-20 min

RINSE-scope and channels rinsed with sterile, filtered or tap water followed by alcohol

DRY-use forced air to dry insertion tube and channels STORE-prevent recontamination

Surgical Site InfectionSurgical Site Infection

SSIs third most common HAI, accounting for 14-23% of HAIs Among surgical patients, SSIs were most common accounting for

~40% of healthcare-associated infections 67% incisional infections (confined to incision) 33% organ/space infections

Increase an average of 7 days to each hospitalization Increase >$10,000 (2005 $) to each hospitalization Appropriate preoperative administration of antibiotics and other

prevention measures are effective in preventing infection

Surgical Site Infections. Available at: http://www.ihi.org/IHI/Topics/PatientSafety/SurgicalSiteInfections/.Odom-Forren J. Nursing2006. 2006;36(6):58-63.

http://www.ihi.org/IHI/Topics/PatientSafety/SurgicalSiteInfections/

Cost Estimates for Specific Healthcare-Associated Infections

HAI type Weight-Adjusted Cost per HAIMean + SE

Range of Published Estimates of Cost per HAI

VAP 25,072 + 4,132 8,682-31,316BSI 23,242 + 5,184 6,908-37,260SSI 10,443 + 3,249 2,527-29,367CA-UTI 758 + 41 728-810

2005 US dollarsAnderson DJ, et al. ICHE 2007;28:767-773

Clinical and Economic Impact Clinical and Economic Impact

Procedure/Device Devices/yr* Infections/yr Avg. costMortality

*

CARDIO

Heart valves 85,000 3,400 $50,000 High

Vascular grafts 450,000 16,000 $40,000 Moderate

Pacemaker/ICD 300,000 12,000 $35,000 Moderate

LV assist dev. 700 280 $50,000 High

NEURO

CNS shunt 40,000 2400 $50,000 Moderate

Adapted from: Darouiche RO. N Engl J Med. 2004;350:1422-429.*Darouiche RO. Clin Infec Dis. 2001;38:1567-1572.

Clinical and Economic Impact Clinical and Economic Impact

Procedure/Device Devices/yr* Infections/yr Avg. costMortality

*

ORTHOPEDIC

Joint prosthesis 600,000 12,000 $30,000 Low

Fracture fixator 2,000,000 100,000 $15,000 Low

PLASTIC

Breast implant 130,000 2600 $20,000 Low

UROLOGICAL

Penile implant 15,000 450 $35,000 Low

Adapted from: Darouiche RO. N Engl J Med. 2004;350:1422-429.*Darouiche RO. Clin Infec Dis. 2001;38:1567-1572.

Surgical Site InfectionSurgical Site Infection

Advances in infection control practices Improved operating room ventilation Sterilization methods Barriers Surgical technique Antimicrobial prophylaxis

SSI: Pathogenesis

Risk of surgical site infections =

Dose of bacterial contamination x virulence (toxins)

Resistance of the host

SSI: Primary Risk FactorsSSI: Primary Risk Factors

Endogenous microorganisms Skin-dwelling microorganisms

Most common sourceS aureus most common isolateFecal flora (gnr) when incisions are near the perineum or

groin Exogenous microorganisms

Surgical personnel (members of surgical team) OR environment (including air) All tools, instruments, and materials (extremely rare)

Mangram AJ, et al. Infect Control Hosp Epidemiol. 1999;20(4):250-278.

SSI: CDC GuidelinesSSI: CDC Guidelines

Patient characteristics

Preoperative issues

Intra-operative issues

Postoperative issues

Mangram AJ, et al. Infect Control Hosp Epidemiol. 1999;20(4):250-278.

CDC Surgical Site Infection Prevention Guidelines - 1999

Category IA and IB

No prior infections 15 air changes/hr in ORDo not shave in advance Keep OR doors closed Control glucose in D.M. pts Use sterile instrumentsStop tobacco use Wear a maskShower with antiseptic soap Cover hairPrep skin with approp. agent Wear sterile glovesSurgical team nails short Gentle tissue handlingSurgical team scrub hands DPC for heavily contaminated

Exclude I/C surgical team woundsGive prophylactic antibiotics Closed suction drains (when

used)Pos pressure ventilation in OR Sterile dressing x 24-48 hr

SSI surveillance with feedback to surgeons

Surgical Infection PreventionArch Surg 2005;140:174

40.792.947.6All Surgeries (34,133)

79.190.852.4Hysterectomy (2,756)

41.075.940.6Colon (5,279)

36.397.452.0Hip/knee (15,030)

44.891.940.0Vascular (3,207)

34.395.845.3Cardiac (7,861)

Antibiotic stopped within 24 hours

%

Correct Antibiotic

%

Antibiotic within 1 hour%Surgery (N)

INCREASING DEMANDS ON ICPsWITH ACCOUNTABILITY

Public expectation of 0 rate of healthcare-associated infections?

Buy in by legislatures and CMSIC accountability and attention rich but resource poor

ICP ACTIVITIES

1975 to 1990 Surveillance Outbreak investigations Exposure evaluations Education JCAHO Policy development and

review Sterilizer monitoring Dialysis water

1991 to 2003 (new) Targeted surveillance OSHA TB OSHA Bloodborne Molecular epidemiology MRSA, VRE BT preparedness Construction rounds

ICP ACTIVITIES

2004 to 2008 (new) IHI bundles CMS core measures NSQUIP (VAs, others) NDNQI (ANA) Other CQI initiatives MRSA active surveillance Unannounced TJC visits Avian influenza preparedness Endoscope sampling

Future Public health reporting Mandated influenza vaccine Mandated MRSA surveillance Cost analyses Comprehensive surveillance Transparency

Prevent Surgical Site Infections:Institute for Healthcare Improvement

Components or “bundle” if implemented reliably can eliminate SSIs Appropriate use of antibiotics Appropriate hair removal Maintenance of postoperative glucose control for major

cardiac surgery patients Establishment of postoperative normothermia for colorectal

surgery patients“Bundle” is a group of interventions related to a disease process that, when executed together

result in better outcomes than when implemented individually.

Institute for Healthcare ImprovementVAP AND CA-BSI BUNDLES

VAP Bundle Elevation of the head of the

bed to between 30 and 45 degrees

Daily “sedation vacation” and daily assessment of readiness to extubate

Peptic ulcer disease (PUD) prophylaxis

Deep venous thrombosis (DVT) prophylaxis (unless contraindicated)

CA-BSI Hand hygiene Maximal barrier precautions Chlorhexidine skin antisepsis Optimal catheter site

selection, with subclavian vein as the preferred site for non-tunneled catheters

Daily review of line necessity, with prompt removal of unnecessary lines

University of North Carolina Health Care

Ventilator-associated pneumonias Leads to an increased length of stay, 13 days Substantial cost to the healthcare institution, about $24,400 Mortality about 30%

Catheter-related bloodstream infections Leads to an increased length of stay, 14 days Substantial cost to the healthcare institution, about $25,000

(not reimbursed by CMS, Oct 2008) Mortality about 20%

UNC Health Care ICUs Central Catheter-Associated Bloodstream Infections

8.49.4

6.6

9.5

6.45.9 5.8

6.67.5

4.7 4.4 4.14.7

4.23.5 3.4 3

0

2

4

6

8

10

12

14

Infe

cti

on

s/1

00

0 C

ath

ete

r D

ay

s Medical Staff education

Dressing kit with Chloraprep

Nursing education

Custom insertion kits with antiseptic catheters

IHI

Hospital EpidemiologyConfidential Information for CQI

University of North Carolina Health CareHow We Are Doing Overall: VAPs

UNC HCS All ICUs VAP Rates

0

2

4

6

8

10

2004 Q

1

2004 Q

2

2004 Q

3

2004 Q

4

2005 Q

1

2005 Q

2

2005 Q

3

2005 Q

4

2006 Q

1

2006 Q

2

2006 Q

3

2006 Q

4

2007 Q

1

2007 Q

2

2007 Q

3

2007 Q

4

Infe

ctio

n R

ate

(# In

fectio

ns /

1000

Ven

tila

tor

Days)

PUBLIC REPORTING

Who decides Legislature (with input from advocacy groups) Executive branch Independent commission (NC)

What’s reported Specific infection rates (e.g., CR-BSI) All surveillance data?

Who has access to the data Public health department Public

CMS Reimbursement Deniedfor Healthcare-Associated Infections

New CMS guidelines will deny reimbursement for: Vascular catheter-associated infections Catheter-related UTIs Mediastinitis after CABG

CMS is proposing to expand the list of conditions by 9 to include: SSI following certain elective procedures Legionnaires’ disease Ventilator-associated pneumonia S. aureus septicemia Clostridium difficile associated disease


Health insurance reimbursement tied to meeting quality goals

Incentive package would involve metrics that are clinically meaningful and measurable. Patient satisfaction Ventilator-associated pneumonia, target NHSN Central-line associated bacteremia, target NHSN Hand hygiene, compare to literature Prophylactic antibiotics within one hour of surgical incision

Targeting ZeroD Murphy, APIC 2007

Set goal at zero (BSI, VAP, SSI, MRSA) Strong leadership, MD support, Department champions Use the bundle approach to evidence-based prevention

measures Real-time root-cause analysis when a HAI occurs Personalize HAIs (information about people not rates) Data shared relentlessly with staff, leadership Teamwork essential and team success celebrated Market the value of infection prevention to leadership

University of North Carolina Health Care

MICU Ventilator Associated Pneumonia Rates

-1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Infe

cti

on

Ra

te (

# In

fec

tio

ns

/ 1

00

0

Ve

nti

lato

r D

ay

s)

MICU Catheter Associated Bloodstream Infection Rates

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Infe

ctio

n R

ate

(# In

fect

ion

s / 1

000

Cat

het

er D

ays)

MANAGEMENT OF MRSA IN HOSPITALS:IMPACT OF MRSA

126,000 hospitalized patients infected annually 3.95 MRSA infections per 1,000 discharges

>5,000 deaths >$2.5 billion excess health care costs due to MRSA 9.1 days excess length of stay (LOS) >$20,000 in excess cost per case (range, $7,000-

$32,000) 4% in excess in-hospital mortality

MANAGEMENT OF MRSA IN HOSPITALS:5 MILLION LIVES CAMPAIGN (IHI)

Improved hand hygiene Decontamination of the environment and equipment Active surveillance cultures for MRSA colonization

~9.5% admission to UNCHC MICU colonized ~6.5% admissions to UNCHC SICU colonized

Contact isolation for infected and colonized patients Device bundles (Central Line and Ventilator Bundle)

RATIONALE FOR SCREENING PATIENTS FOR MRSA

Patients colonized or infected with MRSA represent the major reservoir of MRSA in healthcare settings

33% to 91% of colonized patients are NOT detected by routine clinical cultures

Transmission of MRSA from non-isolated patients occurs 16 times more often than from isolated patients

Impact of active surveillance cultures on MRSA acquisitions or infections 16/18 (89%) published articles reported substantial reduction

The Joint Commission2009 Chapter: National Patient Safety Goals

Goal 7-reduce the risk of HAIs Compliance with WHO and CDC hand hygiene Implement evidence-based practices to prevent HAIs

due to multiply drug-resistant organisms Implement evidence-based practices to prevent

central-line associated bloodstream infections Implement best practices for preventing surgical site

infections

CONCLUSIONS

Healthcare-associated infections are associated with significant patient morbidity and mortality

Implementation of IHI bundles demonstrated to reduce VAP and CR-BSI infections

Compliance with infection prevention recommendations needed to prevent HAIs

New issues: public reporting; CMS non-reimbursement for HAIs; National Patient Safety Goals (TJC); insurance reimbursement tied to quality goals

CONCLUSIONS

Current challenges Increased emphasis on preventing HAIs; increased

demands on ICP time Lack of compliance with hand hygiene and policies Institution of IHI bundles and other CQI activities Public reporting, mandated vaccines, mandated practices Multidrug pathogens: VRSA, MDR-GNRs, XDR-TB Emerging pathogens: C. difficile, norovirus Public desire for 0 rate of healthcare-associated

infections

CONCLUSIONS

Future Gene therapy-genes introduced into human cells Xenotransplanation-organs from nonhuman species to

human recipients emerged due to shortage of human organs

Emerging pathogens? Influenza pandemic? Bioterrorism?

Thank you

ACKNOWLEDGEMENTS

Thanks to the following persons for slides David Weber Karen Hoffmann Jay Fishman Ron Jones Jason Stout

challenges for infection prevention in the 21 st century william a. rutala, ph.d., m.p.h. unc health...

Documents

endoscope slide

nc slide

increase slide

management of healthcare

common infections

joint commission slide

unc health care

rates of healthcare