Healthcare Hygiene magazine December 2019 | Page 34

patient safety & quality
By Kathy Warye
Combating AMR: The Importance
of Transparency in Reporting
T
he recent update to the Center for Disease Control
and Prevention (CDC)’s AMR Threat Report, published
in early November, has garnered considerable attention. It
contains both good news and bad news in the battle against
resistant organisms and healthcare-associated infections
(HAIs) in general. but the key message is not a good one.
Since the last report in 2013 AMR has been rising far more
rapidly than previously understood.
While significant progress has been made in reducing
rates of MRSA, C. difficile and certain device-related HAIs,
rates of the one of the most serious emerging organisms,
Carbepenem resistant Enterococci (CRE), was underestimated
by 50 percent. In an interview with The Washington Post,
Micheal Craig, CDC senior advisor, stated that, “A lot
of progress has been made, but the bottom line is that
antibiotic resistance is worse than we previously thought.”
This situation is not without precedent.
In 2006, the Association for Professionals in Infection
Control and Epidemiology (APIC) conducted the first,
national study of MRSA prevalence. The study found
significantly higher rates of MRSA in U.S. hospitals than
had been previously estimated. With the emergence of a
community-associated strain and reports of deaths from
MRSA among those with no previous hospitalization, the
study generated considerable attention from the media and
contributed to pressure on policy-makers to ensure more
accurate tracking.
Beginning in 2009, hospitals were required to report
MRSA bacteremia to the National Healthcare Safety Network
(NHSN), a comprehensive HAI databased managed by
the CDC, as a condition of participation in Medicare and
Medicaid. The federal policy had two important, features:
the requirement for acute-care hospitals to routinely submit
data on MRSA bacteremia to the NHSN, and transparency. In
addition to the tracking provision, rates of MRSA by institution
were made available to the public. Prior to enactment of
this policy, the real burden of MRSA was largely unknown
to national healthcare leadership and little information on
MRSA rates and deaths was available to the public.
In most countries with well-developed healthcare systems,
reporting of organisms of concern is a key component of
broader programs to protect public health. In 2006, with
MRSA on the rise, the United Kingdom made reporting
of MRSA bloodstream infections to the National Health
Service mandatory. Reporting was the initial phase of a more
comprehensive strategy to prevent transmission and deaths
which resulted in a drop of close to 40 percent in MRSA
isolates. Across Europe, The European Centre for Disease
Prevention and Control (ECDC) promotes the transparent
34
reporting of outbreaks and organisms of concern. Reporting
is viewed as an important catalyst in driving attention to the
problem, an effective component of a larger reduction effort
and a foundation for regional coordination.
While it could be argued that public reporting is
burdensome for hospitals, accurate tracking of resistant
organisms is critical if we are to have the data upon which
to base containment and other strategies. And if CRE or
another resistant organism yet to emerge mutates into a
community-associated strain, as with flu outbreaks, the
public will have the right to know where it is emerging.
More importantly, it is well accepted in management and
quality circles that what gets measured, gets managed. In
the context of MRSA, the federal reporting mandate enabled
not only more accurate measurement of the burden of MRSA
but made the problem of MRSA front and center on the
healthcare leadership radar. The public availability of hospital
specific data drove leadership accountability and initiated a
decade long improvement in infection prevention resourcing
and infrastructure in U.S. hospitals.
Currently, only two resistant organisms are subject to
reporting, MRSA bacteremia and C. difficile. CRE was
designated by CDC in the 2013 CDC AMR Report as an
“urgent” threat and described by the Director at the time as
the “nightmare, triple threat bacteria.” Unlike MRSA and C.
difficile, there is no federal requirement for reporting of CRE
or repository of data on the emerging resistant organisms
of greatest concern. This obstructs efforts at comprehensive
national surveillance and leads to a less than accurate picture
of the magnitude of the problem.
More importantly, without accurate estimates and
transparency, healthcare institutions may downplay the
threat and deprioritize the investments in infection prevention
and laboratory capacity that will be needed to prevent
transmission, morbidity and mortality and future growth
in resistance.
It is time for CRE and Candid auris, another rapidly
growing resistant organism, to be added to federal reporting
requirements because what gets measured, gets managed.
Transparency drives accountability. And accountability
drives the attention and resources that infection prevention
programs at the institutional and regional levels must have if
they are to effectively act as the front line in defense against
these threats to public health.
Kathy Warye is the founder and CEO of Infection
Prevention Partners where she provides strategic guidance
on the commercialization of solutions that detect, prevent
or manage infection.
december 2019 • www.healthcarehygienemagazine.com