Landmark Developments in Infectious Diseases

A 20-Year Look-Back: Two Steps Forward, One Step Back

Ingrid G. Hein

Disclosures

October 20, 2015

In This Article

Healthcare-Associated Infection

Good surveillance does not necessarily ensure the making of the right decisions, but it reduces the chances of wrong ones.

—Alexander Langmuir, Epidemic Intelligence Service, CDC[34]

Important changes have occurred in the healthcare system to prevent healthcare-associated infection in the past 20 years. For example, adherence to handwashing in hospitals and clinics has become something we now take for granted.

Dr John Lynch, medical director of the Harborview Medical Center Infection Control, Antibiotic Stewardship, and Employee Health programs, says that it's only in the past 10-15 years that research papers show evidence of how prevention improves infection. "Twenty years ago, the typical infection control department was a nurse or two. Today, there is an entire department to ensure infection control."

"For so many years, there was just an acceptance of what we now know is preventable," says Lynch. He points to a 1999 report by the Institute of Medicine as having a profound effect on hospitals by looking more closely at error and infection reduction. The report, To Err Is Human,[35] stated that at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented.

The Federal Steering Committee for the Prevention of Health Care-Associated Infections was established in 2008, and in 2009, the Steering Committee developed the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination.

The National Healthcare Safety Network introduced the notion of volunteer reporting on prevention techniques, and by 2011, such reporting was required. "That's when infection control in hospitals really went from the back corner to right out front," Lynch says.

A 2013 randomized study led by Susan Huang looked at targeted vs universal infection prevention mechanisms in the intensive care units of multiple hospitals.[36] The study showed that infection prevention interventions really made a difference, says Lynch.

Although a 2014 survey by the CDC on the prevalence of healthcare-associated infections showed that 1 in 25 hospital patients has at least one healthcare-associated infection,[37] overall, these infections are on the decline. The CDC National and State Healthcare-Associated Infections Progress Report published in 2015 found that there had been a 46% reduction in central line-associated bloodstream infections between 2008 and 2013, a 19% decrease in surgical-site infections, and an 8% reduction in hospital-onset MRSA bacteremia. The study also reported a 10% reduction in C difficile infections between 2011 and 2013.

Lynch emphasizes the importance of antibiotic stewardship to help fight infectious disease. "Antibiotics are a public resource, like oil. We share it. We need to steward it." He emphasized the importance of putting preventive measures into place, having good surveillance of infection, and being careful with our use of drugs.

"We can stop with the nihilism," said Lynch. "We understand a lot of the problems we face; we are empowered to bring infection control to the forefront."

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