IC studies to update emerging infections plan
The Centers for Disease Control and Prevention is funding clinical research projects at eight national "Epi Centers" to improve surveillance, prevention, and control of nosocomial infections.
Announced recently in Atlanta at the first International Conference on Emerging Infectious Diseases, the project includes research on such critical issues as the impact of staffing fluctuations on infection rates, which patients are more likely to be infected with antibiotic-resistant pathogens, and the long-term impact of nosocomial infections on individual patients. The Epi Centers - Centers for Excellence in Healthcare Epidemiology and Infection Control - include hospitals and health care systems in eight states. (See locations, research project questions, p. 68.)
"We are encouraging them to not only do research, but to do evaluations and assess interventions," says Steve Solomon, MD, chief of special studies activity in the CDC hospital infections program. "From a CDC standpoint, clearly we are very interested in problems relating to antimicrobial resistance. We are very concerned about infection control and infectious diseases in general in people who may have some impaired host defense or compromised immunity."
In announcing the plan, the CDC reminded that the United States has 1.8 million nosocomial infections annually at a rate of five per 100 admissions in U.S. hospitals. More than 88,000 patients die each year as a result of those infections, which cost an estimated $4.5 billion annually. The Epi Center investigators are expected to publish their own findings while providing important data to the CDC. The research grants are currently for two-year and three-year periods, but CDC officials hope to draw future funding to make the fledgling program an ongoing source of relevant clinical data.
Immediacy is main goal
"Our hope is that this is a long-term program," Solomon says. "This is all applied research. Our goal is that the results of this work ought to be immediately applicable to improving health care quality and to reducing the incidence of health care-associated infections."
The impact of staffing changes on infection rates - a particularly pointed question in the managed care era - will be studied at three centers. A previously published CDC study on the issue concluded that "during health care reform, as hospitals downsize their staff in efforts to contain rising health-care costs, reduced staffing should be considered a potential risk factor for nosocomial infections."1
One of the Epi Centers that will take another look at the issue is Washington University School of Medicine in St. Louis. Hospital epidemiologist Victoria Fraser, MD, is directing a project that includes the university as well as several other health care settings in the area. Frazier and colleagues will look at nosocomial bloodstream infections, ventilator-associated pneumonia, surgical site infections, and urinary tract infections in intensive care units.
"We're collecting data on infected and uninfected patients in a fairly large fashion to really be able to compare and contrast risk factors while controlling for severity of illness," she explains. "Then we are going to be looking at process of care issues - in terms of changes in health care delivery [and] nurse staffing ratios and how that may or may not influence nosocomial infection rates. [We will use] different denominators - patient days, line days, ICU days - as markers of nosocomial infections."
Such studies and publication of the results could draw much-needed public attention, and attendant government funding, to the importance of preventing nosocomial infections, she adds.
"It's really important for the public to be aware how serious the problem of emerging pathogens and antimicrobial resistance is in hospitals," Fraser says. "Also how prevalent nosocomial infections are and what a huge impact they have on health care dollars and outcomes."
While disclosure of hospital infection rates and public discussion of infection control problems remain controversial, Fraser notes that it may be time to abandon the "secretive psychopathology" with which the field has long been viewed. A few highly publicized community outbreaks of E. coli in recent years, for example, led to substantial increases in federal research funding for food-borne diseases, she says. Likewise, nosocomial infections are "a reality of life that needs study just like pulmonary embolisms and C-section rates," she notes.
"It is really important for the CDC to keep doing studies like this and for Congress and the federal government to continue to support studies in infection control and infection prevention - to put federal dollars towards this kind of research," Frazier says. "Because otherwise these problems are never going to be addressed."
Reference
1. Fridkin SK, Pear SM, Williamson TH, et al. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996; 17:150-158.
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