Change begets change for CDC and its advisors

The following reasons were cited in requesting an expansion of the scope and mission of the Centers for Disease Control and Prevention’s hospital infections program and the Hospital Infection Control Practices Advisory Committee (HICPAC). The request was made in a June 18, 1998 letter from HICPAC chairperson Elaine Larson, RN, PhD, FAAN, CIC to U.S. Secretary of Health and Human Services Donna Shalala. The correspondence was distributed at a Nov. 16-17, 1998, meeting of HICPAC at the CDC. Key excerpts of the request are summarized as follows:

• The scope and magnitude of health care-related infections have expanded markedly. The proportion of hospitalized patients who are admitted to intensive care units in acute care settings has increased, and the proportion of the U.S. population who receive long-term or home health care has become as large as those receiving in-hospital care.

• Health care has evolved rapidly in recent years to include a widening spectrum of health care-related services provided in non-hospital settings. These include chronic care, rehabilitation, freestanding dialysis facilities, infusion clinics, home care services, long-term care, outpatient centers, surgicenters, and other non-hospital sites.

• Certain health care-related infections occurring in other countries serve as sentinel events for impending infection control problems in the United States — for instance, the recent emergence of vancomycin intermediate-resistant Staphylococcus aureus in Japan. With the rapid introduction of advanced medical technology in international settings, there is a need to develop an appropriate infection control infrastructure in these settings. Otherwise, significant morbidity and mortality will occur from hospital infections, and we risk transportation of emerging and antimicrobial-resistant pathogens into the United States from these international settings. There is an urgent need to improve surveillance, infection control, and prevention activities in international health care settings.

• Active surveillance for new and emerging infections requires adequate clinical microbiology support. In many international settings there either is no clinical microbiology laboratory or methods used are inadequate to detect these pathogens. Expanding this essential capacity should be a high priority if we are to have a strong international surveillance program and early warning system for these emerging and re-emerging pathogens.

• The CDC hospital infections program should have primary responsibility for prevention and control programs for all pathogens in all health care delivery settings. Because of their unique expertise in health care, the HIP should be the primary source for prevention activities in health care settings.

• Of the emerging infectious diseases issues with relevance in the United States and throughout the world, none are more critical to us than those relating to emerging infections within the health care setting. The impact of health care-associated infectious diseases in terms of quality and cost of health care is enormous. The department should enhance support for health care-associated infection prevention activities through expansion of the mandate and mission of the CDC hospital infections program to include infections beyond the hospital.