Spotlight: Preventing Healthcare Associated Infections

November 2013

For healthcare organizations, preventive measures designed to reduce and eliminate disease transmission occurring within a facility are critical components of patient safety. According to the Centers for Disease Control & Prevention, almost 1.7 million ¹ hospital-acquired infections (HAIs) occur annually, and approximately 99,000² deaths each year are attributable to HAIs. Further, the Department of Health & Human Services estimates that HAIs are responsible for $28 to $33 billion dollars ³ in preventable healthcare expenditures each year.

For the Veterans Health Administration (VA)—one of the largest healthcare systems in the country, providing care to over 8.7 million Veterans ⁴ in 300 VA hospitals and 827 ⁵ community-based outpatient clinics—prevention of HAIs is a priority. Within VA's Office of Public Health, the National Center for Occupational Health and Infection Control focuses on providing evidence-based guidance about preventing and responding to HAIs. To support those efforts, investigators within VA's Health Services Research & Development Service (HSR&D) conduct a variety of research studies focused on detecting and preventing HAIs. The following include just a few of these ongoing investigations.

• Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) Initiative: Advancing MRSA Infection Prevention.
  One of the most significant causes of HAIs is methicillin-resistant Staphylococcus aureus (MRSA), which accounts for an estimated 94,000 invasive infections and 19,000 deaths annually in the US. The four studies within this initiative will examine a number of approaches to preventing and eliminating MRSA within VA.
• Evaluation of a Pulsed-Xenon Ultraviolet Room Disinfection Device.
  Each year, there are approximately 8,000 patient admissions and transfers within the facilities comprising the Central Texas Veterans Health Care System, and each admission or transfer necessitates the intensive cleaning and disinfection of patient rooms. Previous research has shown that manual cleaning that focuses on visible, soiled areas misses 70% of high-touch surfaces. Portable machines emitting pulsed xenon ultraviolet rays (PX-UV), however, effectively kill many microbial pathogens with shorter cleaning times, yielding a practical, less expensive option for routine room disinfection. This study, slated to conclude in 2016, will examine both the clinical and economic benefits of PX-UV decontamination of post-discharge patient rooms.
• Improving Practice: Automated Compliance Monitoring in Infection Control.
  In 2007, VA began a national initiative to reduce the spread of methicillin-resistant Staphylococcus aureus (MRSA). Part of that initiative's success depends on healthcare workers' compliance with hand-hygiene and contact precautions (i.e., hand washing, gowns and gloves worn when entering patient rooms). There are two factors that influence compliance: continuous monitoring of compliance, and direct feedback of compliance rates to healthcare workers. However, direct observation of hand hygiene and gown/glove use are problematic. This study, slated to conclude in December 2013, sought to measure monthly compliance with hand hygiene and glove/gown use; assess risk factors; provide sustained feedback of estimated compliance; and determine if contact isolation modifies or improves healthcare worker behavior, including hand hygiene.
• Using Economics and Epidemiology to Evaluate MRSA Decolonization in VA.
  Treating infectious diseases like methicillin-resistant Staphylococcus aureus (MRSA) can produce spillover effects that impact individuals who are not currently infected. This five-year study (part of HSR&D's Career Development Award program) seeks to evaluate the impact that MRSA has on health care cost and utilization by examining facility-level elimination of MRSA and MRSA infection rates, as well as the impact of MRSA infections on length of inpatient stay and post-discharge costs.

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1. Klevens RM, et al, "Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002". Centers for Disease Control & Prevention, Public Health Reports, March-April 2007. http://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf
2. ibid
3. Department of Health & Human Services website. Section: National Action Plan to Prevent Healthcare-Associated Infections Executive Summary.
4. Department of Veterans Affairs website. Section: National Center for Veterans Analysis and Statistics.
5. ibid

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