Progress Being Made in Infection Control in U.S. Hospitals

Progress has been made in the effort to eliminate infections that commonly threaten hospital patients, including a 46 percent decrease in central line-associated bloodstream infections between 2008 and 2013, according to a report released in January by the Centers for Disease Control and Prevention.  However, additional work is needed to continue to improve patient safety, the CDC says. The CDC’s Healthcare-Associated Infections progress report is a snapshot of how each state and the country are doing in eliminating six infection types that hospitals are required to report to CDC. For the first time, this year’s HAI progress report includes state-specific data about hospital lab-identified methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections and Clostridium difficile (C. difficile) infections (deadly diarrhea).

The annual National and State Healthcare-associated Infection Progress Report summarizes data submitted to the CDC’s National Healthcare Safety Network, the nation’s health care-associated infection tracking system. Health care-associated infections are a major, yet often preventable, threat to patient safety. On any given day, approximately one in 25 U.S. patients has at least one infection contracted during the course of their hospital care.

“Hospitals have made real progress to reduce some types of health care-associated infections — it can be done,” says CDC Director Tom Frieden, M.D. “The key is for every hospital to have rigorous infection control programs to protect patients and health care workers, and for health care facilities and others to work together to reduce the many types of infections that haven’t decreased enough.” On the national level, the report found a:

  • 46 percent decrease in central line-associated bloodstream infections (CLABSI) between 2008 and 2013. A central line-associated bloodstream infection occurs when a tube is placed in a large vein and either not put in correctly or not kept clean, becoming a highway for germs to enter the body and cause deadly infections in the blood.
  • 19 percent decrease in surgical site infections (SSI) related to the 10 select procedures tracked in the report between 2008 and 2013. When germs get into the surgical wound, patients can get a surgical site infection involving the skin, organs, or implanted material.
  • 6 percent increase in catheter-associated urinary tract infections (CAUTI) since 2009; although initial data from 2014 seem to indicate that these infections have started to decrease. When a urinary catheter is either not put in correctly, not kept clean, or left in a patient for too long, germs can travel through the catheter and infect the bladder and kidneys.
  • 8 percent decrease in MRSA bloodstream infections between 2011 and 2013.
  • 10 percent decrease in C. difficile infections between 2011 and 2013. 

For more information on national goals for reducing health care-associated infections, see the Healthy People 2020 objectives for HAIs: www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections.

Vanderbilt-led Flu Surveillance Study Tracks Pediatric Vaccination Rates

A study appearing in the January edition of Pediatrics, led by researchers at Vanderbilt University Medical Center, looks at how Nashville children ages 6 months through 5 years fared over 11 consecutive flu seasons concluding in 2010-11.
Immunization recommendations changed during this period. Ahead of the 2007-08 flu season, for the first time, the immunization schedule published annually by the Centers for Disease Control and Prevention recommended annual flu vaccination for most children ages 6 months to 5 years.

For this age group, this vaccination had previously been recommended only for certain high-risk individuals. (Since 2011, the CDC has recommended annual influenza vaccination for nearly everyone.)

Researchers found that in the 2010-11 flu season in Nashville, vaccine uptake among these children reached an estimated 38 percent, compared with single-digit rates reported for the city in the early 2000s, before CDC recommendations were changed.

The authors say it’s too early to see any clear effect from increased vaccination rates on overall flu-associated emergency department visits or hospital admissions. “More data are needed to assess long-term trends in influenza-associated medical care use in children,” they wrote.

Under this Vanderbilt-led, CDC-sponsored surveillance, young children with influenza symptoms are enrolled at selected Nashville health care locations during each flu season, respiratory samples are gathered for laboratory confirmation of influenza and providers are contacted to confirm influenza vaccination.

Over those 11 flu seasons, among this age group the estimated total flu-related emergency department visits in Nashville ranged from 352 to 2,324 per season, and hospitalizations ranged from 7 to 60. During the final season covered by the study, 2010-11, the total estimated flu encounters included 1,418 ED visits and 16 hospital admissions. 

“Active surveillance like that conducted at Vanderbilt has been crucial to demonstrate the burden of influenza among young children and to inform public policy,” said one of the authors, Carlos Grijalva, M.D., associate professor of Health Policy.

“Data have revealed the large burden of disease caused by influenza among young children. The availability of vaccine provides an opportunity to mitigate the impact of this infection, but availability is not enough — the vaccine must be given,” he said.

In addition to funding from the CDC, the study was also supported by National Institutes of Health grant TR000445.

Coupling Head, Neck Cancer Screening and Lung Cancer Scans Could Improve Early Detection, Survival

Adding head and neck cancer screenings to recommended lung cancer screenings would likely improve early detection and survival, according to a multidisciplinary team led by scientists affiliated with the University of Pittsburgh Cancer Institute, a partner with UPMC CancerCenter.

In an analysis published in the journal Cancer and funded by the National Institutes of Health, the team provides a rationale for a national clinical trial to assess the effectiveness of adding examination of the head and neck to lung cancer screening programs. People most at risk for lung cancer are also those most at risk for head and neck cancer.

“When caught early, the five-year survival rate for head and neck cancer is over 83 percent,” said senior author Brenda Diergaarde, assistant professor of epidemiology at Pitt’s Graduate School of Public Health and member of the UPCI. “However, the majority of cases are diagnosed later when survival rates generally shrink below 50 percent. There is a strong need to develop strategies that will result in identification of the cancer when it can still be successfully treated.”

Head and neck cancer is the world’s sixth-most common type of cancer. Worldwide every year, 600,000 people are diagnosed with it and about 350,000 die. Tobacco use and alcohol consumption are the major risk factors for developing the cancer.

The early symptoms are typically a lump or sore in the mouth or throat, trouble swallowing or a voice change, which are often brushed off as a cold or something that will heal. Treatment, particularly in later stages, can be disfiguring and can change the way a person talks or eats.

Diergaarde and her team analyzed the records of 3,587 people enrolled in the Pittsburgh Lung Screening Study (PLuSS), which consists of current and ex-smokers aged 50 and older, to see if they had a higher chance of developing head and neck cancer.

In the general U.S. population, fewer than 43 per 100,000 people would be expected to develop head and neck cancer annually among those 50 and older. Among the PLuSS participants, the rate was 71.4 cases annually per 100,000 people.

Recently, the U.S. Preventive Services Task Force, as well as the American Cancer Society and several other organizations, recommended annual screening for lung cancer with low-dose computed tomography in people 55 to 74 years old with a smoking history averaging at least a pack a day for a total of 30 years. The recommendation came after a national clinical trial showed that such screening reduces lung cancer mortality.

“Head and neck cancer is relatively rare, and screening the general population would be impractical,” said co-author David O. Wilson, M.D., M.P.H., associate director of UPMC’s Lung Cancer Center. “However, the patients at risk for lung cancer whom we would refer for the newly recommended annual screening are the same patients that our study shows also likely would benefit from regular head and neck cancer screenings. If such screening reduces mortality in these at-risk patients, that would be a convenient way to increase early detection and save lives.”