THCB

Protecting Americans from Preventable Infections: Working Together Will Save Lives

Tom Frieden CDC“Alone we can do so little; together we can do so much.” Those words spoken by Helen Keller nearly a century ago remain powerful and relevant today.

A new report from the Centers for Disease Control and Prevention (CDC) projects that thousands of lives could be saved every year if health care facilities and public health departments work together to track and stop antibiotic resistance – and if they communicate with each other about these infections to prevent spread from one facility to another.

Even if one health care facility follows all recommended infection control practices, antibiotic-resistant organisms can spread when patients are transferred among facilities. Even the best health care facilities can’t go it alone when it comes to antibiotic-resistant infections and C. difficile.

We need to protect our whole community; advance warning of possible antibiotic-resistant infections at one facility allows actions to be taken to prevent spread at the receiving facility.

New modeling data from CDC project that a community-wide approach – in which hospitals, long-term acute care facilities, nursing homes and health departments across an area work together – could reduce the number of patients infected with carbapenem-resistant Enterobacteriaceae (better known as CRE) by up to 70% over five years. CRE is a nightmare bacteria because it does not respond to most antibiotics and is extremely deadly should it enter the bloodstream – especially if a patient is already sick. A significant drop in these infections would be a life-saving scenario for patients.

Health care facility administrators are key to making this coordinated approach a success. Hospitals, long-term acute care facilities and nursing homes all need better systems to alert one another when transferring patients carrying drug-resistant bacteria and C. difficile. Strict infection control practices must be implemented in every health care setting, and clinical staff need access to prompt and accurate laboratory testing to identify antibiotic-resistant bacteria.

Public health departments must play a central role by tracking antibiotic-resistant threats in the area and alerting facilities to their presence. State and local health departments should dedicate staff to improve awareness and coordination between facilities to better prevent infections.

Proposed funding in the President’s budget for Fiscal Year 2016 will help turn this proven, life-saving approach into reality nationwide. The proposed budget includes funding for ‘State Protect Programs’ in all 50 states and 10 large US cities. These investments would help health care facilities better prevent outbreaks, improve antibiotic prescribing and save lives. The budget proposal for CDC also supports implementation of CDC activities in the National Strategy for Combatting Antibiotic-Resistant Bacteria (CARB), which President Obama has made a top priority for improving America’s health security.

Continuing on our current path will result in hundreds of thousands more antibiotic-resistant infections plus thousands more deaths every year. Now it is up to Congress to support the vital resources needed to protect Americans from drug-resistant bacteria and the risk of a post-antibiotic age that will undermine many of the life-saving procedures of modern medicine we have come to rely on.

We need to act now to improve the way antibiotics are used in our nation so we can reduce drug-resistant bacteria. I write these words while on travel related to Ebola and other infectious disease control in Africa, where traditional wisdom notes that if you want to go fast, go alone, but if you want to go far, go together. Together we can do so much.

Tom Frieden is the Director of the Centers for Disease Control and Prevention.

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4 replies »

  1. The elephant in the room is respiratory infections. Practically every business, clinic and hospital that I know of has several mini-epidemics every year of whatever the respiratory virus du jour happens to be. Contrary to folk lore about the “common cold” many if not most of these folks develop flu-like illnesses, with a predictable course of prednisone and antibiotics for sinusitis and bronchitis. That cycle greatly increases the rate of inappropriate antibiotic prescribing and current work rules regarding PTO, keep all of the index cases there infecting everyone else. Hospitals and clinics seem to focus on hand washing as prevention. While necessary it does not explain that fact that you can culture respiratory viruses from the HVAC systems in hospitals.

    There is what I would see as massive denial about the mortality and morbidity associated with respiratory viruses. The medical community needs to get serious about the prevention and treatment of these viruses that also happen to be an entry point for inappropriate antibiotic prescriptions.

    George Dawson, MD

  2. Thanks for your important perspective. This coordinated approach is a big undertaking with some tough challenges, but we’re committed to making it work to protect the lives of Americans. EHRs have great promise. CDC is working to find innovative ways to get information to clinicians about threats such as antibiotic resistance. CDC’s National Healthcare Safety Network (NHSN) is ready to receive EHR data from hospital labs to track antibiotic use and resistance data; a good use of EHR to help combat AR. Still, there are plenty of challenges to tackle, including ensuring that IT vendors produce systems that can interact efficiently and allow EHRs to be a tool for protecting patients. But we don’t need to wait for a perfect EHR solution; even low tech coordination by IPs picking up the phone to alert a colleague, or making a note in a chart when a patient is headed to a nursing home can help stop spread. Listen to this presentation from Tennessee Health Department and other states about their approach (http://www.cdc.gov/stltpublichealth/townhall/2015/08/vitalsigns.html) or the transcript of the CDC COCA call featuring clinicians from Rush University talking about their approach.

  3. It’s funny. I kept asking the state department of public health in CA “can’t you come out with something like the MMWR that tells the clinicians ‘what is going around?’

    I gavr up. Your answer, Allan, is the right one. They can’t.

  4. “thousands of lives could be saved every year if health care facilities and public health departments work together to track and stop antibiotic resistance – and if they communicate with each other”

    They can’t. They are too busy working on their EHR’s

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