Either/or: Will injection safety or antibiotic resistance be the top priority in next phase of HHS plan?

March 18th, 2015

Two incredibly important infection control issues – injection safety and antibiotic resistance – are vying to be the top priority in the next phase of the Department for Health and Human Services (HHS) Action Plan to Prevent Healthcare-Associated Infections (HAIs), Don Wright, MD, MPH, Deputy Assistant Secretary for Healthcare Quality at the HHS, said recently in Anaheim at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC)

This will be the fourth phase of the sweeping federal initiative, which has achieved some dramatic reductions in HAIs since it began in 2008 but is still struggling to affect Clostridium difficile and catheter-associated urinary tract infections (CAUTIs).

“Over the next year we will tackling the next phase -- the candidates for that are still being discussed,” Wright said. “We are considering phase four being injection safety for a variety of reasons. There continue to be significant outbreaks related to injection safety and we also know with the demographics of increasing numbers of diabetics in the country the opportunity to [reduce HAIS] related to glucose monitoring and insulin injection. Another topic that is being considered is antimicrobial resistance and antibiotic stewardship. It is an issue that has great momentum in Washington, D.C., with the White House becoming interested as well as Congress."

Given the increasing emphasis on antibiotic resistant infections, some of which are becoming virtually untreatable, one would think that would be the obvious choice over injection safety. However, recall that it was the massive hepatitis C exposure incident in 2008 in a Las Vegas endscopy clinic that drove national demands for action to prevent HAIs. Making matters worse, as originally reported in Hospital Infection Control & Prevention, CMS inspectors had actually visited the Las Vegas clinic but failed to recognize the reuse of single dose vials and other flagrant infection control breaches.

According to the CDC more than 50 outbreaks linked to unsafe injection practices have occurred since 2001, exposing thousands of patients to bloodborne pathogens and leading to transmission of HCV, hepatitis and bacterial infections. In addition, patients have been infected with HCV and other pathogens by receiving contaminated solutions tainted by addicted health care workers diverting drugs for their use. Outbreaks and patient notification events have occurred in hospitals, primary care clinics, pediatric offices, ambulatory surgical centers, pain remediation clinics, imaging facilities, oncology clinics, and health fairs.

For more on this story see the August 2014 issue of Hospital Infection Control & Prevention