Infection Prevention Action Plan Updated

Surveying hospitals for compliance with infection control plans and establishing goals for the vaccination of hospital employees against influenza were among the recommendations contained in an update to the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination released in early June 2013.  Health care-associated infections (HAIs) are infections that individuals receive while receiving treatment for medical or surgical conditions in a health care setting.  The initial HAI Action Plan, released in 2009, focused on HAI prevention in acute care hospitals.  The 2013 update reports that hospitals were meeting goals established in the 2009 plan for the reduction of the most common HAI.  In addition to the new requirements for hospitals, the 2013 update included a discussion on HAI prevention strategies at ambulatory surgical centers and end-stage renal disease facilities. This report and the original 2009 report were prepared by the members of a steering committee comprised of clinicians, scientists, and public health leaders from numerous federal agencies.

New Strategies for Hospitals

The 2013 update stated that when hospitals are being surveyed for compliance with the Medicare conditions of participation (CoPs) they should also be surveyed to see if they are in compliance with their own infection control program, as well as national standards for reducing HAI.   The 2013 update states that a hospital’s infection control program should be required to be an integral part of the hospital’s quality assessment and performance improvement program.  The 2013 update noted that CMS is expected to require the use of an infection control survey tool by surveyors beginning in fiscal year 2013. The tool is based on a tool used in surveying ambulatory surgical centers.

Vaccinations

The 2013 update  establishes a goal by the end of 2015 of having 75 percent of health care personnel (HCP) in a hospital vaccinated against influenza on a yearly basis and that 90 percent of HCP annually receive the influenza vaccine by 2020.  HCP are all paid and unpaid persons working in a health care setting who have the potential for exposure to patients. Physicians, nurses, laboratory personnel, facility administrative staff, and volunteers are considered HCP.

In 2009, Loyola University Medical Center in Illinois made annual influenza vaccination a requirement for employment.  An analysis of the vaccination rates at that hospital found that in 2009, 99.2 percent of employees received the vaccine, 0.7 percent were exempt for religious or medical reasons, and 0.1 percent chose termination of employment instead of begin vaccinated.  Jorge Parda, M.D. and professor of medicine at Loyola University Chicago Stritch School of Medicine, who was the study’s author said, “Our employees and associates now understand that this is the way we do business.  Just as construction workers must wear steel-toed boots and hard hats on job sites, healthcare workers should get a flu shot to work in a hospital.” The study found that overall 64 percent of health care personnel across the nation were vaccinated against the flu.

Accomplishing Goals

In 2009 the steering committee established goals for the reduction of the most common HAIs.  In the 2013 update, the steering committee reported that hospitals were on target to meet their associated five-year goals by the end of 2013.  Those goals were a 25 percent reduction in catheter-associated urinary tract infections; a 50 percent reduction in central line-associated bloodstream infections; a 50 percent reduction in MRSA invasive infections; and a 25 percent reduction in surgical site infections.

These reductions  and reductions in newly identified areas such as ventilator-associated events are essential to improving care and saving costs. The report stated that “at any given time about one in 20 hospitalized patients has an HAI, while over one million HAIs occur across health care every year.”  Treating HAIs increases the cost of health care by an estimated $28 to $33 billion each year.  The steering committee establishes goals and strategies to improve care and reduce these costs.