APIC cites a few caveats, concerns about HHS 2020 infection targets

January 12th, 2015

While expressing overall support with proposed federal reduction targets for health care associated infections, the Association for Professionals in Infection Control and Epidemiology (APIC) raised several concerns in comments to the Department of Health and Human Services (HHS). The HHS has proposed a new set targets for infection reduction in acute care hospitals for 2020.

HHS: Reduce central line‐associated bloodstream infections (CLABSI) in intensive care units and ward‐located patients by 50% from 2015 baseline. Data Source: Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN)

APIC: We support this target; however, we suggest that the target not only reflect aggregate data, but that interim assessments of the rate also be stratified by ICUs and non‐ICUs. This methodology will help to better understand the areas needed for improvement and is also currently proposed for the CAUTI metric. We applaud the CDC for their efforts in working with oncologists, infection preventionists, and hospital epidemiologists to develop and evaluate a Mucosal Barrier Injury (MBI) bloodstream infection definition and for excluding MBI from the target. However, because this is a new designation, it is difficult to predict how using the new definition and excluding those cases will impact the 2015 baseline.

HHS: Reduce catheter‐associated urinary tract infections (CAUTIs) in intensive care units and ward‐located patients by 25% from 2015 baseline. Data Source: CDC/NHSN

APIC: We support this target, but with reservations. We are concerned about the existing NHSN definition and the influence of the fever criteria. Further, we believe flaws in the definition may impede accurate measurement. We urge the development and testing of an electronic definition incorporating data that most facilities would have electronically available.

HHS: Reduce the incidence of invasive health care‐associated methicillin–resistant Staphylococcus aureus (MRSA) infections by 75% from 2007‐2008 baseline (Healthy People 2020 Goal). Data Source: CDC’s Emerging Infections Program Network (EIP) Active Bacterial Core Surveillance (ABCs)

APIC: We generally support this target, and note its inclusion as a Healthy People 2020 goal. However, we want to point out that it is particularly aggressive given the prevalence of the community‐onset MRSA strain in the general population. We believe that, in order to assist with achieving this target HHS should more widely disseminate information such as lessons learned from the CDC’s EIP/ABC network.

HHS: Reduce the rate of Clostridium difficile hospitalizations by 30% from 2015 baseline. Data Source: Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP).

APIC: We appreciate the value of understanding both hospital‐onset and community‐onset C. difficile infection (CDI). However, since community‐onset C. difficile is, by definition, not an HAI, we believe that including both hospital‐onset and community‐onset C. difficile as a measure in a plan intended to eliminate healthcare‐associated infection is misleading. We also believe that consumers would be better served by the use of more precise data to identify HAIs.