Cathryn L. Murphy, PhD, RN, MPH

Disclosures

March 30, 2010

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My name is Cathryn Murphy and I am honored to represent the 13,000 worldwide members of the Association for Professionals in Infection Control and Epidemiology (APIC) as their 2010 President.

As global experts gather to address issues relating to the prevention of healthcare-associated infections (HAIs), we remain painfully aware that the World Health Organization reports that more than 43 million or more persons around the globe are currently suffering with a healthcare-associated infection, referred to as an HAI. In American hospitals alone, HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year. These global and United States figures are both staggering and compelling. These are the unsettling statistics that drive APIC members and our peers in the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America to find better solutions toward saving lives and healthcare dollars.

Between 5% - 15% of all hospitalized patients around the world will develop an HAI during their hospital stay.[1] An estimated 60% of these infections are thought to be related to the use of invasive devices.[2] The paradox here is uncanny: these devices are both life-saving and life- threatening. The most commonly occurring device-related infections are ventilator-associated pneumonias (VAP), central line associated bacteraemia (CLAB) and catheter-associated urinary tract infections (CAUTI).

We know from recent research undertaken by a global consortium of 173 ICUs from 25 countries that the rate of device use is consistent among developed and developing countries.[3] However, the rates of HAI related to devices are in most cases between 3 to 5 times greater in developing countries compared to developed countries.

Experts suggest several reasons for this anomaly. The fundamental difference between these settings appears to be related to infection prevention capacity, which includes the ability to accurately identify, measure and analyze cases of HAI. It also includes the provision of regular feedback to clinicians and the standardized use of evidence-based interventions. For example, in central-line insertion, these have included appropriate hand hygiene, adequate skin preparation, use of maximum sterile barriers, and site-specific dressings. Use of these measures is routinely guided by a standardized checklist. The interventions are important individually and are recognized in the scientific literature for their collective ability to eliminate intrinsic and extrinsic patient risk, subsequently reducing HAI incidence.

Over the past 40 years in the developed world, we have built and have continued to refine our infection prevention capacity. More recent investment by governments and greater interest from media and the public alike continue to drive our HAI prevention activities. Manufacturers continue to advance medical device research and developments as they offer clinicians new and exciting technologies and medical devices, many of which are designed with specific features or compositions believed to reduce the potential for infection.

In contrast, in the developing world, formalized infection prevention programs and evidence-based interventions are only just beginning to be recognized as foundations for HAI prevention. In many parts of the world, availability and/or regulation of medical devices as we know in the U.S. are minimal. Delivery of evidence-based care remains a hypothetical goal. Governments do not routinely recognize, support, or invest in infection prevention initiatives. HAIs, including device-related infections, are often unrecognized and unmonitored and as such, improved patient safety through HAI reduction is unlikely.

Despite these anomalies between the device-related HAI risk in developed and developing worlds, we remain optimistic as we celebrate the success of some of our U.S. peers who have successfully managed to obtain and sustain zero HAI rates for some specific device-related infections such as CR BSIs and VAP.[4,5,6] They have done so through the introduction of simple measures such as checklists that detail sequential clinical interventions as bundles that clinicians are encouraged to routinely apply.

In addition to these specific, and often simple, but standardized clinical measures, experts suggest that equally empowering all members of the clinical team to question potential or actual infection prevention breaches, provides another layer of protection for the patient.

Device use and HAI prevention are not mutually exclusive. Standardization of practice and empowerment are simple measures that can be applied in any setting and in any country regardless of its affluence or healthcare system. These simple measures will be crucial as the world predictably increases its use and range of devices in the provision of healthcare.

Improving compliance with fundamental infection prevention measures such as hand hygiene, better monitoring of HAIs and more judicious use of antimicrobials are additional measures that can be applied routinely and irrespective of their setting by many clinicians around the world in our greater effort to reduce the global HAI burden. However it is to be achieved, prevention of device-related infections must be one of the key goals of our community over the next decade.

Web Resource

APIC Elimination Guides. Available at: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/APICEliminationGuides/APIC_Elimination_Gui.htm Accessed April 1, 2010.

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