Arizona hospitals reduced patient-infection rates, but antibiotic-resistant infections here remain a threat to safety, a federal report says.
Many of the most urgent and serious “superbug” antibiotic-resistant bacteria are a risk to patients while they are being treated in health care facilities for other conditions, and may lead to sepsis or death, federal officials say.
The Centers for Disease Control and Prevention estimates that on any given day, 1 in 25 patients have an infection that they picked up in the hospital. Officials have been pushing hospitals to do a better job keeping infections in check, with the government’s Medicare program cutting payments to the worst hospitals.
The CDC looked at data from thousands of U.S. hospitals from 2008 through 2014, focusing on infections tied to certain surgical procedures and use of catheters.
Arizona significantly lowered its rate of Clostridium difficile, or C-diff, and Central Line-Associated Bloodstream infections (CLABSIs) between 2013 and 2014, the data show.
“We are trending in the right direction in the majority of the areas,” said Sandra Severson, vice president of care improvement for the Arizona Hospital and Healthcare Association. “But the work never stops. We still have a lot of work to do.”
Severson said about half of C-diff infections are caused by inappropriate antibiotic usage, and that both providers and patients need to be mindful of appropriate antibiotic use. Hand hygiene and cleaning hospital rooms are also extremely important as the organism can live for long periods on hard surfaces, Severson said.
C-diff is the most common type of bacteria responsible for infections in hospitals.
CLABSIs can occur when a tube is placed in a large vein and not put in correctly or kept clean. It can become a way for germs to enter the body and cause deadly infections in the blood.
Arizona’s rates of catheter-associated urinary tract infections , surgical site infections and MRSA infections showed no statistically significant change, the report says.
The state’s rates of MRSA, while unchanged, were higher than the national standardized infection ratio, which is a risk-adjusted summary statistic used to track health care-associated infection prevention over time.
Arizona a pilot state
Arizona recently signed on to become one of five pilot states to work with the CDC on targeting C-diff, MRSA as well as other infections, Severson said.
The federal report released Thursday urges health care workers to use a combination of infection control recommendations to better protect patients from antibiotic resistant infections.
In acute-care hospitals, 1 in 7 catheter- and surgery-related health care-acquired infections can be caused by any of six antibiotic-resistant bacteria.
That number increases to 1 in 4 infections in long-term acute-care hospitals, which treat patients who are generally very sick and stay, on average, more than 25 days.
The six antibiotic-resistant threats examined in the report are: Carbapenem-resistant Enterobacteriaceae (CRE); Methicillin-resistant Staphylococcus aureus (MRSA); ESBL-producing Enterobacteriaceae (extended-spectrum-lactamases); Vancomycin-resistant Enterococcus ; multidrug-resistant Pseudomonas aeruginosa; and multidrug-resistant Acinetobacter.
Antibiotics became widely available in the 1940s, and today are used to kill or suppress the bacteria behind everything form strep throat to the plague.
But as decades passed, some antibiotics stopped working. Experts say their overuse and misuse have helped make them less effective. Health officials have been raising alarms about it for years.
Fighting the problem requires more careful and judicious use of antibiotics, CDC director Dr. Tom Frieden said. “Doctors are the key to stamping out superbugs,” Frieden said.
The report offered some good news: The rate of overall infection did continue to fall for certain surgical sites and catheters.
One emerging and serious threat to patient safety is CRE, said Dr. Clifford McDonald, associate director for science at the CDC’s Division of Healthcare Quality Promotion.
“We’re probably most concerned about those that are resistant to all known antibiotics and that’s the CRE,” McDonald said. “CRE is really always resistant to all the drugs you want to be able to use … It is one of our urgent threats. It’s urgent because it is so highly resistant.”
CRE, which has been called the ‘nightmare bacteria,’ first emerged around 2000, he said. It’s most common in long-term acute-care hospitals, McDonald said.
While CRE infections have occurred in Arizona, they are not a reportable condition in the state, said Holly Ward, a spokeswoman for the Arizona Department of Health Services.
That means the state does not receive routine reports from health care providers or laboratories on CRE and therefore does not have comprehensive data on the number of cases that occur, she said.
CRE is a continuing concern that the state is working to address, she said.
“Our Healthcare Associated Infections Advisory Committee recently released a fact sheet on CRE for use in skilled nursing facilities, and our state lab has the ability to conduct testing for these organisms by request,” Ward said.
In fiscal year 2016, Congress appropriated $160 million in new funding for the CDC to implement its national plan to combat antibiotic-resistant bacteria.
The plan includes:
- accelerating outbreak detection and prevention in every state.
- enhancing tracking of resistance mechanisms and resistant infections.
- supporting innovative research to address current gaps in knowledge.
- improving antibiotic use.
Providers have the power
The CDC is also calling on health care workers to continue to do their part to prevent health care-acquired infections.
The report recommends doctors and nurses combine three critical efforts to accomplish this:
- Prevent the spread of bacteria between patients.
- Prevent infections related to surgery or placement of a catheter.
- And improve antibiotic use through stewardship.
“Doctors and health care facilities have the power to protect patients — no one should get sick while trying to get well,” Frieden said.