Washington is poised to do something to help the
healthcare system cope with the serious problem of healthcare-associated
infections (HAIs) and the increase in antibiotic-resistant pathogens.
President Obama has spoken about increasing funding for diagnostic
science, comparative effectiveness, and a healthcare IT stimulus. His
policies seem to propose some sober and realistic solutions to some of
this nation’s healthcare problems.
As a society, we have put off asking some tough
questions that simply cannot be ignored.
- Can we realistically manage the
antimicrobial-resistance problem that, by many estimates, is
expected to get worse? - With a national healthcare budget that commits
only 5% of funding to diagnostics, are we as a country willing to
invest more? - Will the diagnostic process — which provides up
to 60% to 70% of the empirical data used in patient care — continue
to be under valued and under funded?
The longer we delay asking and answering these
questions, the more complex the problems become. The impact of
antibiotic-resistant infections on treatment costs and patient outcomes
is alarming. We have a vital role in diagnosing HAIs as fast as possible
so clinicians can treat patients appropriately and use antibiotics
prudently, while improving care and patient outcomes, and reining in
unnecessary costs.
- In just 10 years, Staphylococcus aureus,
which was once described as a “controllable nuisance,” has evolved
into methicillin-resistant S aureus (MRSA) — one of the
fastest-growing resistant infections that does not respond to most
antibiotics. - In 1993, there were fewer than 2,000 MRSA
infections in U.S. hospitals. By 2005, the figure shot up to
368,000, according to the Agency for Healthcare Research and Quality
(AHRQ). - About 70% of bacteria that cause infections in
hospitals are resistant to at least one of the drugs most commonly
used to treat infections. - Another organism once considered controllable,
Clostridium difficile, can survive on dry surfaces, such as
medical scrubs, for long periods of time. The Centers for Disease
Control and Prevention, or CDC, reports that over the past two
years, several states have reported increased rates of C diff-associated
disease and an associated increase in mortality. - Vancomycin-resistant enterococci, or VRE, poses a
serious health threat. Unfortunately, scientists believe that the
organism has transferred a key antibiotic-resistance gene to S
aureus. - HAIs, the most common complication of hospital
care, accounted for an estimated 1.7 million infections and 99,000
associated deaths in 2002. The financial burden of these infections
is staggering: HAIs create an estimated $30 billion in excess
healthcare costs each year, according to AHRQ. - These avoidable infections result in more than 8
million additional days spent in the hospital.
Diagnostic tests can play
a significant role in such
[infection-control] policies,
helping substantially reduce HAI prevalence and associated costs.
Reducing HAIs requires healthcare establishments to
implement infection-control policies to screen patients, manage
outbreaks, and monitor epidemiology. Diagnostic tests can play a
significant role in such policies, helping substantially reduce HAI
prevalence and associated costs. Education is key to resolving HAI
problems. Training and peer-to-peer sharing of best practices and
solutions have worked for many hospitals. A number of educational
resources are available at
www.bioMerieux-usa.com/education ,
www.apic.org , and
www.ahrq.gov .
We have held a series of HAI workshops over the past
year, bringing together leading researchers and clinicians with clinical
lab scientists in California, Indiana, and New York. There is a real
thirst for information regarding technology and best practices to avoid
HAIs and to mitigate their spread when they occur. Attendance exceeded
our expectations, and the enthusiasm and urgency attendees demonstrated
surprised us, so we plan to expand this program to include workshops in
Colorado, South Carolina, Florida, Maine, Texas, Wyoming, and
Washington.
The Second Global HAI Forum in France in 2009 brought
infectious-disease specialists from around the
world together to examine current trends and data and engage in a lively
scientific exchange about future challenges and actions to take in the
fight against HAIs. The experts proposed the bundling of preventive
actions, which have proven to be effective in several countries, to
fight against MRSA: patient isolation, reinforced hygiene, screening,
and decolonization of carriers.
We need to stay a step ahead. Washington cannot do this alone. In
fact, none of us can — not hospitals, microbiologists,
infectious-disease experts, or healthcare corporations. We need to work
together. Together, we can solve these problems, because waiting for
Washington is a luxury we cannot afford.
Herb Steward is executive vice president and general
manager at bioM’erieux North America. Steward completed undergraduate
work in biomedical engineering and holds a BA in management/marketing
and an MBA/MA in finance.
