Maintaining the Momentum of Change: The Role of the 2014 Updates to the Compendium in Preventing Healthcare-Associated Infections

Edward Septimus, MD; Deborah S. Yokoe, MD, MPH; Robert A. Weinstein, MD; Trish M. Perl, MD, MSc; Lisa L. Maragakis, MD, MPH; Sean M. Berenholtz, MD, MHS


Infect Control Hosp Epidemiol. 2014;35(5):460-463. 

In This Article


Healthcare-associated infection (HAI) prevention is the quintessential patient safety issue. HAIs are the fifth leading cause of death in acute care hospitals. Up to15% of patients develop an infection while hospitalized. In the United States, this accounts for approximately 1.7 million HAIs and 99,000 deaths annually.[1] A recent report estimated US healthcare system costs attributable to the five most common HAIs (central line–associated bloodstream infections [CLABSI], catheter-associated urinary tract infections [CAUTI], ventilator-associated pneumonia [VAP], surgical site infection [SSI], and Clostridium difficile infection [CDI]) to be $9.8 billion, even without considering the sizable societal costs.[2] While there has been dramatic progress in controlling four of the five most common HAIs, the emergence of multidrug-resistant organisms (MDROs) has reached critical levels. The recent Centers for Disease Control and Prevention (CDC) report "Antibiotic Resistance Threats in the United States, 2013"[3] indicated that each year in the United States, at least 2 million people acquire serious infections from organisms resistant to one or more antimicrobial agents, resulting in 23,000 deaths per year. The report advocates preventing these multidrug-resistant infections through immunization, appropriate use of antimicrobial agents, and adherence to infection prevention practices, including hand hygiene.

In the last several years, major changes in US healthcare have impacted HAI prevention. These developments include improved interdepartmental coordination of federal efforts aimed at HAI prevention,[4] posting of hospital-specific HAI rates on public websites to promote transparency,[5] and linking of hospital-specific HAI performance to financial reimbursement as a strategy to motivate hospitals' HAI prevention efforts.[6] As a consequence of the Deficit Reduction Act of 2005 and the Affordable Care Act of 2010, hospitals participating in the Centers for Medicare and Medicaid Services (CMS) Inpatient Prospective Payment System (IPPS) have been required since 2011 to report CLABSIs among patients in intensive care units (ICUs) to the CDC's National Healthcare Safety Network (NHSN) in order to qualify for annual payment updates. Since 2012, hospital-specific CLABSI rates have been publicly accessible.[5] Additional data reported through NHSN to CMS already are, or soon will be, accessible, including SSI rates following abdominal hysterectomy and colon surgery, CAUTI, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections, CDI, and receipt of influenza vaccination by healthcare personnel. Along with other quality metrics, these HAI data will be used to determine hospital-specific CMS reimbursement levels as part of value-based purchasing, thereby shifting some of the costs associated with HAIs from CMS to hospitals. Despite this increased focus on HAI prevention, a recent national survey of infection preventionists indicated that only 13% reported receiving more hospital support following implementation of CMS IPPS reporting requirements, and about one-third reported that the emphasis on reportable HAIs led to less time available for prevention of other nontargeted HAIs.[7]