This article is more than 5 years old. Information may no longer be current.
The Fifth Decennial Conference: Some reflections
Click Here to Manage Email Alerts
The Fifth Decennial International Conference on Healthcare-Associated Infections – 2010 is now history. And a memorable conference it was. Since I was privileged to be on the planning committee for the first in this series of conferences, held (by definition) in 1970, and have attended all the subsequent ones, I’ve spent some time reflecting on what has happened to these meetings over the past few decades.
The first conference, held in the old Auditorium A at CDC (for those of you who might remember that room,) was attended by perhaps 100 to 125 people, mostly from the United States, but just enough from other countries to justify the word “international” in the conference title. Professor R.E.O. Williams, from the Wright-Fleming Institute in London was the keynoter and delivered the conference summary as well. Those who attended or read the proceedings recall that he did a masterful job.
Over the years, the decennial conferences have grown in attendance, yet never wavered from their home location in Atlanta. In contrast to the limited attendance in 1970, the 2010 conference had about 4,000 pre-registrants and perhaps about 500 who registered onsite; it rivaled the size of an Infectious Diseases Society of America meeting. Furthermore, it was easily the most international in character of all the decennial conferences; there were registrants from more than 75 other countries, many of whom were speakers or displayed posters.
The goal of these decennial conferences has always been the same: (1) to assess where we are in scientific knowledge at each 10-year interval, and (2) to determine, insofar as possible, the research agenda for the next decade. I must admit that when I first became aware of plans for the 2010 conference, my initial reaction was “who needs it?” The Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control (APIC) are by this time mature organizations, with their own journals and annual scientific meetings, and the Division of Healthcare Quality Promotion at CDC is mature and well-respected. In addition, there are also a number of country organizations devoted to this topic in the United Kingdom, other countries in Europe and elsewhere. So why should we get together yet again?
It didn’t take much further reflection to provide the answer. I’m not aware of any other organization or field of interest that does anything like this. There may be some, but I’m not aware of any. The number of people around the world with a research interest in health care-associated infections is still sufficiently limited that it is still possible to get most of us together for an international forum to achieve the goals I’ve outlined above.
There are social purposes in getting together as well. Individual social interactions are obvious, and were certainly abundantly evident among people both from the United States and other countries. But there were organizational social purposes as well. SHEA and APIC, for example, do not talk to each other nearly as often as they should, and this conference provided an opportunity to do so. The same is true of CDC’s Division of Healthcare Quality Promotion and the other sponsoring organizations.
“Bundles” and “checklists” were words frequently heard during the conference, as were phrases like “implementation science.” A few of the highlights will be discussed in future editorial comments.
Conference highlights
In the remainder of this column, I’d like to highlight what for me were two of the best 10-minute presentations at the conference.
The first, by Mike Edmonds and his colleagues at Virginia Commonwealth University Medical Center was titled: “The Demise of Methicillin-resistant Staphylococcus Aureus (MRSA) at an Academic Medical Center.” Using only an aggressive hand hygiene program, a central line “bundle,” chlorhexidine bathing of all adult ICU patients, “bare below the elbows” recommendations for HCWs to reduce contact with contaminated clothing and jewelry, and compliance monitoring and feedback, these investigators achieved stunning reductions in MRSA rates over a seven-year period from 2003-2009 as follows: There was a 91% reduction in MRSA central line-associated bloodstream infections, a 62% reduction in MRSA UTI, and a 92% reduction in MRSA VAP. All this was accomplished without active surveillance measures.
This same theme of sharp declines in MRSA incidence using aggressive standard precautions, but without active surveillance measures, was echoed in a number of presentations, both from the United States and Europe. One wonders whether we are seeing, at least in part, a long-term secular trend emerging, perhaps comparable to the decline of the old aggressive phage type 80/81 infections during the 1960s. I have raised this issue in previous editorials, and it bears raising again.
A point to be emphasized, however, is that this seems to be happening without the use of active surveillance. If this decline is sustained over the longer term, those of us who have resisted the introduction of active surveillance will feel vindicated. There is a danger, however, and that is that all the state legislatures that have required active surveillance may now try the old epidemiologists trick of stepping in at the height of an epidemic and then “riding to glory on the downhill curve,” to quote the father of the EIS Program, Alex Langmuir.
The second presentation was by Ed Septimus and his colleagues, on behalf of the Hospital Corporation of America. These investigators implemented a program that required all patient-contact employees to either be vaccinated against influenza or wear a surgical mask in patient-care areas. This was implemented throughout the corporate entity consisting of 163 hospitals, 112 outpatient centers and 368 physician practices. There was support of this program from the corporate CEO and the Chief Medical Officer, and there was a great deal of preparation and education at the local hospital level. Declination statements were required to be signed by those declining vaccine.
As of Nov. 1, 2009, 140,599 employees had been offered vaccine, and 135,584 (96%!) were vaccinated. This was a stunning accomplishment, considering that the program was carried out in the largest corporate health care provider in the country. As with the studies reported from the Barnes Jewish Health Care Hospitals, however, it was not clear how many attending physicians participated, or what the vaccination rate was. That group remains a tough nut to crack, as it were.
Thus the movement toward mandatory influenza immunization in health care facilities continues to expand. The vast majority of us who work in hospitals that do not mandate influenza vaccine will need to re-examine our positions on this issue. One could only wish we were dealing with a better vaccine!
One final kudo: Dr. Denise Cardo of CDC’s Division of Healthcare Quality Promotion, as the conference steering committee co-chair, was clearly the on-site “go to” person. When not presenting or moderating, she was lurking everywhere in the background, making sure that it all happened as advertised. Well done!