Herd Immunity: Better Definitions and Better Data Could Help Stop Superbugs
We know more about cows in remote ranches than drug-resistant infections in thousands of healthcare facilities nationwide.
So what should be done? Daniel Saman and Dr. Kevin Kavanagh at Health Watch USA have done a lot of noodling and doodling about this.
At a minimum, Saman and Kavanagh think that all healthcare-associated infections should be counted in clinics, nursing homes, dialysis centers, all hospitals regardless of size, and other facilities and then reported to state and federal agencies. And when they say "all," they mean all. Federal rules now allow for too many infections to go uncounted. For example, facilities are only required to report central-line associated bloodstream infections (CLABSI) that occur in intensive care units. CDC itself has noted that "CLABSI rates outside ICUs may be similar to rates of these infections in ICUs."
Saman and Kavanagh also think that surveillance systems should be used to track infections, rather than relying on reporting by understaffed hospitals that fear reprisals in terms of federal funding cuts or media scandals. This is already happening in some states, which have started to require their health care facilities to participate in the CDC's National Healthcare Safety Network.
And what about the resulting data? Health Watch USA would like to see aggregate data released to the regularly, which would allow the creation of an infection-density map similar to the cow-density maps created by the United States Department of Agriculture.
Better data was listed as one of the pillars for eliminating infections in a November 2010 paper written by staff from the CDC, the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and others: Moving toward elimination of healthcare-associated infections. They wrote:
The elimination of HAIs will require 1) adherence to evidence based practices; 2) alignment of incentives; 3) innovation through basic, translational, and epidemiological research and 4) data to target prevention efforts and measure progress. These efforts must be underpinned by sufficient investments and resources.
The authors also wrote:
Investments for timely and high-quality data should be focused on (1) reshaping standard definitions and surveillance methods to fit the new, emerging information system paradigms (e.g., electronic health information records and data mining); (2) creating national and global data standards for key HAI prevention metrics; and (3) creating or refining the data analysis and presentation tools available to prevention experts, clinicians, and policy makers at the local, state, national, and international levels.
This wasn't the first time policymakers, researchers and advocates proposed better monitoring and analysis of healthcare-associated infections. Yet significant roadblocks remain.
One of these roadblocks is reluctance on the part of the hospital industry to submit to state monitoring of healthcare-associated infections. The Kentucky Hospital Association, for example, lobbied earlier this year against a state monitoring and reporting system.
"Transparency in infection rates has already been adequately addressed through federal mandates," wrote Michael T. Rust, the association's president, in a letter to state legislators.
I sent Rust and his communications director an email asking for comment on March 18, but I have not received a reply. One can understand Rust's reluctance to create yet another layer of bureaucracy for his members. But Health Watch USA has shown to devastating comedic effect with its cow comparison how far those federal mandates fall short. I have an interim proposal that I'm going to make in an upcoming post, and I'll let you know how you can get involved.
Do you have a thought about how best to track MRSA and other healthcare-associated infections to improve patient safety without creating unnecessary bureaucracy? Share it in the comments below, send it to askantidote [at] gmail [dot] com or ping me on Twitter @wheisel.
Photo credit: Nathan Reading via Flickr