Experts debate intervention strategies for health care-associated infections

The pros and cons of pathogen-directed infection strategies to prevent health care-associated infections were presented.

Infection control programs may include both horizontal (non-pathogen directed interventions) and vertical (pathogen directed interventions) strategies, said John Jernigan, MD, MS, of the division of Healthcare Quality Promotion at the CDC. “The debate is about whether infection control programs should use horizontal strategies exclusively, or whether a combination of horizontal and vertical strategies is needed to optimize control of health care-associated infections.”

Jernigan presented the pro position that vertical interventions are necessary, and Anthony Harris, MD, MPH, of the University of Maryland School of Medicine, maintained the con position that pathogen-directed interventions are not necessary, but rather, non-pathogen directed interventions (horizontal strategies) will achieve optimal control of health care-associated infections.

Complimentary approaches needed

Although Jernigan said horizontal approaches are essential for infection control programs, horizontal strategies should be supplemented with vertical strategies to maintain optimal control of health care-associated infections.

He said, for example, that hand hygiene alone may not be 100% effective at preventing transmission, in part because there is a lack of complete adherence, and removal of pathogens from contaminated hands is often incomplete with hand hygiene.

“Although standard precautions and hand hygiene are sound and effective practices, and are the very cornerstone of [health care-associated infection] prevention efforts, there are no data suggesting that they are 100% effective at preventing transmission of health care-associated pathogens. In fact, it is difficult to get a precise estimate of the effectiveness at preventing nosocomial transmission,” he said.

Jernigan said horizontal interventions should be the foundation of infection control programs; however, there are limitations. “For some pathogens, the epidemiological differences are important enough, especially given the limitations of the horizontal approaches available to us today, to warrant complimentary approaches.”

Non-pathogen interventions work

Harris said, most, if not almost all SHEA guidelines recommend non-pathogen directed interventions. Harris said. “These interventions have the ability to affect multiple bacteria at the same time that contribute to the emergence of antibiotic resistance and health care-associated infections by targeting more than one pathogen.”

Harris said it is important to prove cost-effectiveness in infection control rather than cost savings, which is what has previously been required. “Cost-savings means that the amount of money intervention prevents must be greater than the amount of the intervention.”

Two key interventions for hospital-directed infection prevention include improving hand hygiene compliance and improving compliance with gloves and gowns for patients on contact precautions. Vaccination against influenza is also important.

“As much as we’d like to do both types of interventions, limited resources exist in our institutions, and we must perform cost-effectiveness decisions to choose,” Harris said. “Non-pathogen directed initiatives, at this point, are far superior in the cost-effectiveness argument. With an unlimited amount of resources, we would do both, but we do not have unlimited amount of resources.”

For more information:

• Harris A. #672.
• Jernigan J. #671.

Disclosures: Drs. Jernigan and Harris report no relevant financial disclosures.

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