CDC Modeling Shows Safe Health Care Means Coordination

August 4, 2015 by CDC's Safe Healthcare Blog

Scott Fridkin, MD

CDC’s Dr. Scott Fridkin
Senior Advisor for Antibiotic Resistance in Health care

Today CDC released its latest Vital Signs report, which includes mathematical modeling that projects increases in drug-resistant infections and Clostridium difficile (C. difficile) without immediate, nationwide improvements in infection control and antibiotic prescribing. The report includes recommendations that would impact how health care facilities and public health departments work together through a “coordinated approach” and shows promise for the fight to slow antibiotic resistance if these actions are adopted.

To prevent illness and saves lives, the report recommends a coordinated, two-part approach to turn this modeling data into action:

Public health departments track and alert health care facilities to drug-resistant germ outbreaks in their area and the threat of germs coming from other facilities, and
Health care facilities work together and with public health authorities to implement shared infection control actions to stop the spread of antibiotic-resistant germs and C. difficile between facilities.

Facilities work together to protect patients.

The CDC modeling projects that a coordinated approach—that is, health care facilities and health departments in an area working together—could prevent up to 70 percent of life-threatening carbapenem-resistant Enterobacteriaceae (CRE) infections over five years. Additional estimates show that national infection control and antibiotic stewardship efforts led by federal agencies, health care facilities, and public health departments could prevent 619,000 antibiotic-resistant and C. difficile infections and save 37,000 lives over five years.

As you may know, antibiotic-resistant germs, those that no longer respond to the drugs designed to kill them, cause more than 2 million illnesses and at least 23,000 deaths each year in the United States. C. difficile caused close to half a million illnesses in 2011, and an estimated 15,000 deaths a year are directly attributable to C. difficile infections.

The Vital Signs report shows that C. difficile and drug-resistant bacteria—like CRE, MRSA (methicillin-resistant Staphylococcus aureus), and resistant Pseudomonas aeruginosa—spread inside of and between health care facilities when appropriate infection control actions are not in place and patients transfer from one health care facility to another for care. One important finding to point out is that even facilities following recommended infection control and antibiotic use practices are at risk when they receive patients who carry these germs from other health care facilities.

The modeling that the report includes gives us a unique look at the future of resistant infections if we maintain status quo infection control and don’t work to adopt the coordinated approach recommendations. For example, the model shows how coordination could reduce CRE over the course of five years after drug-resistant bacteria enters 10 facilities in an area sharing patients. For example:

The common approach (or status quo) results in 2,000 patients getting CRE, impacting 12 percent of patients in the area – not enough to protect patients.
When a facility acts alone to enhance their infection control practices, the situation improves. This independent effort results in 1,500 patients getting CRE, impacting 8 percent of patients – while an important improvement, it is not enough to fully protect patients.
With a coordinated approach where facilities work together to prevent infections and notify each other of CRE issues before transferring patients, the modeling shows far fewer patients at risk. Four hundred patients are predicted to get CRE, impacting only 2 percent of patients – the needed approach to protect patients.

The report also describes the importance of public health departments taking the lead to:

Identify health care facilities in the area and know how they are connected.
Dedicate staff to improve connections and coordination with health care facilities in the area.
Work with CDC to use data for action to prevent infections and improve antibiotic use in health care.
Know the antibiotic resistance threats in the area and state.

Complementing the public health coordination, the report recommends that hospital owners and health care facility administrators consider steps to:

Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
Review and perfect infection control actions in each facility.
Make leadership commitments to join area healthcare-associated infection (HAI)/antibiotic resistance prevention activities.
Connect with public health departments to share data about antibiotic resistance and other HAIs.
Provide clinical staff access to prompt and accurate laboratory testing for antibiotic-resistant germs.

This Vital Signs report is not just about data; it is about action. We know what works to protect patients and stop the spread of resistant germs. With everyone working together and coordinating efforts, we can stop the rising tide of resistance.

To learn more about how the data in Vital Signs was gathered and for other resources associated with the report, visit:http://www.cdc.gov/drugresistance/resources/stop-spread.html

To learn how CDC has proposed to tackle C. difficile infection and antibiotic resistance, and potentially cut the incidence of C. difficile, health care CRE, and MRSA bloodstream infections by at least half, visit: http://www.cdc.gov/drugresistance/solutions-initiative/index.html

Additional Resources