New Infection Control Guidelines - How will the hospitals respond?

I received this on email today. Digesting the article as I post it. How will hospitals respond? Is it practical?
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October 9, 2008
Infection Control Guidelines Issued

By KEVIN SACK

Hoping to improve infection control in hospitals, the nation’s topepidemiological societies joined Wednesday with the American HospitalAssociation and the Joint Commission, which accredits hospitals, to issue acompendium of guidelines for preventing six lethal conditions.The unified backing of the hospital association and the accrediting agencyshould give the recommendations some teeth. The Joint Commission’s vicepresident, Dr. Robert A. Wise, said his agency would spend the next yearstudying which guidelines it would add to its accrediting standards in 2010.

The recommended practices, like vigorous hand-washing before the insertionof catheters and warnings against using razors to remove hair beforesurgery, do not vary in significant ways from the encyclopedic guidelinesissued and revised over the last two decades by a government advisorypanel.But their authors said they had been written more clearly and concisely,with advice not only on what hospitals should do, but also on what theyshould not, and on secondary approaches to try if first-line measures donot lower infection rates.The president of the 5,000-member hospital association, Richard J.Umbdenstock, said the guidelines, which were two years in the making,represented the first “professional consensus” on strategies to minimizeinfections. “As of today, the nation’s infection control team has a commonplaybook,” Mr. Umbdenstock said at a news conference in Washington.

The other groups that produced the guidelines are the Infectious DiseasesSociety of America, the Society for Healthcare Epidemiology of America, andthe Association for Professionals in Infection Control and Epidemiology. Epidemiologists contend that the challenge in reducing hospital infections,which are said to attack one of every 22 patients, has not been a dearth ofguidelines but a lack of adherence.A survey of hospitals last year by The Leapfrog Group, which advocates forhealth-care quality, found that 87 percent did not consistently followinfection-control guidelines. Studies have found that half of hospitalworkers do not follow hand-washing protocols. And epidemiologists inhospitals around the country have found that an intense focus on cleanliness and prevention can lead to significant reductions in infectionrates.“Too often where we fail is not in the knowledge but in the execution,”said Dr. Patrick J. Brennan, chairman of the federal Healthcare Infection Control Practices Advisory Committee, which supports the effort.Dr. Wise said his accrediting agency found large variations in hospitals’practices to control infections.“The same hospital which does great at inserting a central line and maintaining that central line might do poorly in the way it handles urinarycatheters,” he said, adding, “All hospitals are partially effective. Few hospitals are completely effective.”The federal Centers for Disease Control and Prevention, which also endorsesthe new guidelines, estimates that there are 1.7 million infection cases ayear in hospitals, and that 99,000 patients die after contracting them(although the infection alone may not be the cause).

It projects the costof treating hospital infections at $20 billion a year.With new research making a compelling case that infections are oftenpreventable, many hospitals have become more aggressive. They have alsobeen prodded by new policies by Medicare and other insurers to not pay forthe added cost of treating patients who develop certain infections. But a persistent problem, hospital officials say, has been the difficultyof translating guidelines into practice.“One of the reasons hospitals are having difficulty now is that when theylook at guidelines they are drinking from a fire hose,” Dr. Wise said.“There are thousands of these things, and they don’t quite know what to dowith them.”The six conditions covered in the guidelines, which run 6 to 16 pages, arecentral-line-associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, surgical siteinfections, Methicillin-resistant Staphylococcus aureus, or MRSA, andClostridium difficile, an intestinal bacteria.Dr. David C. Classen, an epidemiologist at the University of Utah and alead author, said his team surveyed existing recommendations and researchbefore deciding which practices were based in solid science.

Some of the existing guidelines had not been updated in years, Dr. Classen said.Among the additions were recommendations that patients with ventilators bekept in raised hospital beds and that they receive regular antiseptic oralcare.The group did not change standard practices for controlling MRSA, avirulent drug-resistant bacteria that may contribute to 19,000 deaths ayear. It recommends universal testing of patients for MRSA on admission ­so that infected patients might be isolated and treated with specialprecautions ­ only if less burdensome efforts fail to reduce infectionrates.Some hospitals have had great success with prevention programs that includeuniversal screening. But other researchers argue that vigilant hand-washingand other precautions can be just as effective and less expensive whilebetter caring for infected patients.

The guidelines’ authors said the science remained inconclusive.