Health-Care-Associated Infections in Hospitals: Leadership Needed from HHS to Prioritize Prevention Practices and Improve Data on These Infections

GAO-08-283 Published: Mar 31, 2008. Publicly Released: Apr 16, 2008.
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Highlights

According to the Centers for Disease Control and Prevention (CDC), health-care-associated infections (HAI) are estimated to be 1 of the top 10 causes of death in the United States. HAIs are infections that patients acquire while receiving treatment for other conditions. GAO was asked to examine (1) CDC's guidelines for hospitals to reduce or prevent HAIs and what the Department of Health and Human Services (HHS) does to promote their implementation, (2) Centers for Medicare & Medicaid Services' (CMS) and hospital accrediting organizations' required standards for hospitals to reduce or prevent HAIs and how compliance is assessed, and (3) HHS programs that collect data related to HAIs and integration of the data across HHS. GAO reviewed documents and interviewed officials from CDC, CMS, the Agency for Healthcare Research and Quality (AHRQ), and accrediting organizations.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services In order to help reduce HAIs in hospitals, the Secretary of HHS should identify priorities among CDC's recommended practices and determine how to promote implementation of the prioritized practices, including whether to incorporate selected practices into CMS's conditions of participation (COP) for hospitals.
Closed – Implemented
In 2009, HHS established a Steering Committee for the Prevention of Healthcare-Associated Infections which developed a department-wide action plan to reduce HAIs and established a framework for prioritizing the recommended practices in four CDC guidelines. As a result, the Steering Committee identified a subset of priority recommendations related to the prevention of four HAIs: catheter-associated urinary tract infections, intravascular catheter-associated infections, surgical site infections, and ventilator-associated pneumonia. CDC is also in the process of identifying prioritized practices related to the prevention of Clostridium difficile and Methicillin Resistant Staphylococcus Aureus-related HAIs. HHS plans to take additional actions to promote implementation by hospitals of the prioritized practices by, for example, developing a national media campaign to elicit support for the implementation of the prioritized practices and by funding an initiative in 10 states to reduce central line-associated bloodstream infections. By establishing the Steering Committee and prioritizing recommended practices, HHS has taken steps to help reduce HAIs in hospitals which addressed our recommendation. However, HHS does not plan to incorporate any of the prioritized practices into Medicare's infection control Conditions of Participation for hospitals.
Department of Health and Human Services In order to help reduce HAIs in hospitals, the Secretary of HHS should establish greater consistency and compatibility of the data collected across HHS on HAIs to increase information available about HAIs, including reliable national estimates of the major types of HAIs.
Closed – Implemented
HHS has taken several steps which, collectively, address our recommendation. To establish greater consistency and compatibility of the data collected across HHS on HAIs, the following steps have been taken. In 2011, the Centers for Medicare & Medicaid Services (CMS) began requiring hospitals to report central line-associated bloodstream infection (BSI) data to the Centers for Disease Control and Prevention?s (CDC) National Healthcare Safety Network (NHSN) in order to qualify for full payments from Medicare Beginning in 2012, CMS will also require hospitals to report surgical site infection (SSI) and catheter-associated urinary tract infection (UTI) data to NHSN and, in 2013, will require hospitals to report methicillin-resistant Staphylococcus aureus (MRSA) infections, Clostridium difficile infections, and healthcare worker influenza vaccination data to NHSN. To ensure compatibility of HAI data, HHS officials told us that the Agency for Healthcare Research and Quality (AHRQ) has worked with both CDC and CMS to align their definitions and criteria for HAIs under its Common Formats initiative, and that CDC has also adopted CMS's common identifier for participating NHSN hospitals (e.g., CMS certification number (CCN)) within the NHSN system. Additionally, in 2010, AHRQ completed its baseline inventory of HHS data systems and database resources that can be used for HAI measurement entitled ?Longitudinal Program Evaluation of HHS Action Plan to Prevent Healthcare Associated Infections (HAI): Interim Report on Baseline Measures, Inventory and Recommendations.? HHS has also taken the following steps to improve the reliability of national estimates of HAIs. First, CMS has finalized an approach to validating hospital submissions of central line-associated BSIs to NHSN, which will include an annual chart review of 800 randomly selected facilities. In order to further improve the overall reliability of national estimates of HAIs within acute care hospitals, CDC is conducting a national prevalence survey of HAIs, the last phase of which HHS officials expect will end in the summer of 2011. This prevalence survey will help determine the total number of HAIs in acute care hospitals from all causes (i.e., not limited to HAIs associated with specific devices or procedures). In addition, HHS officials told us that CDC and AHRQ have been working together to determine how AHRQ's Healthcare Cost and Utilization Project and data generated by the Medicare Patient Safety Monitoring System can be used to complement national HAI estimates.

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