HICPAC to post guidelines on line
New chairwoman eyes broader mission for panel
The Hospital Infection Control Practices Advisory Committee (HICPAC) is exploring options to expand its mission to other health care settings, and issuing periodically updated on-line versions of its guidelines, the panel’s new chair reports.
Elaine Larson, RN, PhD, dean of the School of Nursing at Georgetown University in Washington, DC, recently moved from being a HICPAC board member to take the chair of the principal infection control advisory committee to the Centers for Disease Control and Prevention. Larson replaces Walter Hierholzer Jr., MD, hospital epidemiologist at Yale New Haven (CT) Hospital, who had been chairman of HICPAC since its first meeting in 1992.
Guidelines no longer written in stone’
The committee was formed to update CDC infection control guidelines, including some that have not been revised since the early 1980s (e.g., employee health). As a result, infection control professionals have had to rely to some degree on guidance that is clearly outdated, but the committee is nearing completion of its fourth updated guideline and has plans under discussion for several more. To keep the recommendations as current as possible, the committee plans to establish a home page on the Internet possibly in 1998 where guidelines could be posted and updated, Larson notes.
"That would be a major breakthrough and really solve problems that the guideline-development process has been struggling with for over a decade," she tells Hospital Infection Control. "We write them and it becomes written in stone."
Questions have frequently been raised about the possibility of the committee issuing guidelines for non-hospital health care settings, but the panel has been constrained by a federal charter that limits its purview to the hospital setting. Given the ongoing restructuring of the health care system and the increasing delivery of care in non-hospital settings, the committee is striving to make its guidelines more applicable in settings like long-term care and home care, Larson says.
For example, the draft HICPAC guidelines for infection control in health care workers expand the definition of those covered, noting in the document that "health care is increasingly being provided outside of hospitals in facilities such as nursing homes, freestanding surgical and outpatient centers, emergency care clinics, and in patients’ homes or during pre-hospital emergency care."1 (See related story, p. 1.)
In addition, the committee is exploring linking up with other advisory panels and medical groups in liaison relationships that could broaden the implementation of the guidelines, she adds. Beyond that, Larson is pursuing options to formally expand the mandate, working with CDC officials in a move that may also involve expanding the charge of the CDC hospital infections program.
"Certainly as the new chair, I will continue to look at appropriate political ways to influence [that] within CDC and the broader federal government," she says. "And the same for the hospital infections program in CDC their charter should be expanded beyond the hospital."
Committee will seek clinician input
One commonly mentioned pitfall of such efforts is that there are scant data on infection control efficacy in non-hospital settings, providing little scientific basis to support the recommendations. The committee must consider such factors in deciding which infection control areas to address in its guidelines, and it will seek input from clinicians through surveys and focus groups in deciding priorities for guideline development.
"We want to formalize a variety of mechanisms, [including] focus groups at the various national meetings to go over with users and practitioners what they see as priorities and top needs for national guidelines," she says.
A new guideline on surgical site infections is currently being drafted by the panel, and updated recommendations on environmental issues in infection control are expected to follow.
There also is interest in developing methods to assess the implementation and impact of the guidelines, but HICPAC recommendations generally carry considerable clout because they are developed in concert with CDC experts and issued as the agency’s official guidance on infection control matters.
"My sense is the guidelines are very powerful in the [infection control] community they are used as the Bible,’" Larson says. "What will help is making sure they are always current so they don’t lose credibility."
As part of the transition of leadership, Hierholzer wrote a farewell memo to HICPAC members summarizing the committee’s work to date and outlining important directions for the future. Hierholzer emphasized the challenge of antibiotic resistance as evidenced by vancomycin resistance appearing in staph strains and urged the committee’s involvement in the issue of emerging and reemerging infections.
"Whether or not VRSE and VRSA lurk on the immediate horizon (and they probably are) ample numbers of competitors exist," he wrote, urging the committee to "carry the flag of infection control into the new century with new methods in new institutions, reminding everyone along the way of the utility of epidemiology in surveillance, prevention, and control of disease."
Reference
1. Centers for Disease Control and Prevention. Draft guideline for infection control in health care personnel, 1997; notice. 62 Fed Reg 47,276-47,327.
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