CDC says providers can cut 125,000 superbug infections per year. Here's how.

Agency says coordination could prevent tens of thousands of deaths

U.S. hospitals and nursing homes should use a coordinated approach to control antibiotic-resistant bacteria, which could help to prevent more than 600,000 potentially deadly health care-associated infections over the next five years, according to a CDC report released Tuesday.

For the report, CDC researchers focused on four of the most-deadly pathogens:

  • Clostridium difficile, commonly known as C. diff;
  • Carbapenem-resistant Enterobacteriaceae, or CRE;
  • Methicillin-resistant Staphylococcus aureus, commonly known as MRSA; and
  • Pseudomonas aeruginosa.

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To gauge how well coordinated efforts could work to control the pathogens, CDC studied regions where hospitals and nursing homes already are sharing information about infected patients, as well as regions where such information is not shared. CDC then assessed whether infection rates would continue as they were if health care facilities:

  • Increased efforts to combat the pathogens on their own;
  • Worked together to combat the infections; and
  • Worked together in tandem with public health authorities.

According to the report, health care-associated infections stemming from just three of the four pathogens could increase by as much as 10% over five years, to about 340,000 annually, if further measures are not taken to curb their spread.

Report findings, recommendations

CDC suggested that if facilities work together on a regional basis, coordinated by a central public health authority, they could drastically improve detection of such infections and potentially save tens of thousands of lives. According to the report, such efforts could:

  • Prevent 619,000 health care-associated infections and 37,000 deaths over a five-year period; and
  • Reduce CRE infection rates by as much as 74% over five years compared with if health care facilities did not better coordinate their efforts.

According to CDC, such an effort would rely on distributing information about facility-acquired infections, including notifying facilities when a patient carrying antibiotic-resistant bacteria is being transferred.

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Under such a model, the central public health authority would collect information from each facility and disseminate the data to other regional health care institutions. The report noted, "Coordinated prevention approaches led by public health agencies, when coupled with intensified facility-based prevention programs, have the potential to more completely address the emergence and dissemination of these organisms."

CDC estimated such efforts would save the health care industry almost $8 billion in treatment costs.

FDA recommends additional cleaning measures for duodenoscopes linked to superbug outbreak

In related news, FDA on Tuesday recommended hospitals follow additional cleaning measures to ensure the safety of duodenoscopes linked to a recent superbug outbreak.

As many as 179 patients could have been exposed to CRE after undergoing a procedure with a duodenoscope—also called an endoscopic retrograde cholangiopancreatography—at UCLA's Ronald Reagan Medical Center between October 2014 and January 2015. Seven patients were confirmed to have CRE infections, and two of those patients died.

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Meanwhile, Cedars-Sinai Medical Center in Los Angeles in March reported that four patients had been infected with CRE and up to 67 more might have been exposed after being treated with the same type of scope.

Details of recommendations

FDA said hospitals should meticulously follow the duodenoscope manufacturer's cleaning instructions after use. In addition, FDA said hospitals that can afford to do so should take several additional safety precautions to reduce infection risks, including:

  • Chemical sterilization;
  • Ethylene oxide sterilization;
  • Microbiological culturing to identify any bacteria that could be present on the scopes after cleaning; and
  • Repeating the manufacturer's cleaning instructions a second time.

FDA recognized some health care facilities might not have the ability to perform its recommended steps, noting they "require specific resources, training and expertise." FDA said, "Therefore, it is critical that staff responsible for reprocessing duodenoscopes have the manufacturer's instructions readily available to promote strict adherence to the reprocessing instructions in the device labeling, understand the importance of their role in reprocessing the device, and maintain proficiency in performing these reprocessing tasks."

Further, FDA said even if hospitals do implement the extra steps, "the risk of infection transmission cannot be completely eliminated."

FDA has said it will continue to investigate infections related to the scopes and monitor injury reports submitted by provider and manufacturers. In addition, FDA spokesperson Jennifer Dooren said the agency is "working with manufacturers as they explore design innovation," such as disposable parts or devices that could be disassembled, which could help to make the devices easier to clean and safer for repeated use (Sun, Washington Post, 8/4; Rau, Kaiser Health News, 8/4; Consumer Reports/Washington Post, 8/3; Clarke, Reuters, 8/4; Gever, "The Gupta Guide," MedPage Today, 8/4; AP/Modern Healthcare, 8/4; Terhune/Petersen, Los Angeles Times, 8/4).

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