The message in To Err is Human was that preventing death and injury from medical errors requires dramatic , systemwide changes , and that recognizing and implementing actions to prevent error – and logically , infections as an extension of adverse events — has the greatest potential impact .
and without CDC-style infection control programs . It was designed to determine whether infection control programs using CDC-recommended practices actually reduced the risks from HAIs . To conduct the study , 338 U . S . hospitals were randomly selected and were stratified by geography , inpatient bed capacity , and teaching status . Approximately half of the study hospitals had established infection surveillance and control programs . As Dixon ( 2011 ) notes , “ When that study showed that hospitals with infection control programs had significantly lower rates of HAIs than did hospitals without such programs , expectations for hospital programs changed . With strong scientific evidence supporting the value of such programs , accrediting organizations such as the Joint Commission mandated that accredited hospitals have infection control programs similar to those recommended by CDC and the professional organizations of hospital epidemiologists and infection control practitioners . The Joint Commission made this an accreditation requirement in 1976 .”
But until the late 1990s , HAIs were , more or less , the healthcare industry ’ s dirty little secret . Then in November 1999 , the public learned about nosocomial infections and other adverse clinical events in a major way when the Institute of Medicine ( IOM ) released its paradigm-shifting report called To Err is Human : Building a Safer Health System and the media seized upon the fact that as many as 98,000 people annually died from medical errors . The message in To Err is Human was that preventing death and injury from medical errors requires dramatic , systemwide changes , and that recognizing and implementing actions to prevent error – and logically , infections as an extension of adverse events — has the greatest potential impact .
The ebb and flow of concern around addressing HAIs seemed to crest in the early- to mid-2000s , when state and federal reporting became significant byproducts of the changing healthcare landscape when the concepts of pay-for-performance , readmission reduction , value-based purchasing , and reduction of hospital-acquired conditions were introduced . In the years since initial healthcare reform and quality improvement efforts were launched , we have seen various public- and private-sector initiatives that have attempted to move the needle of HAI prevention and patient safety .
As Dixon ( 2011 ) observes , “ Beyond its revolutionary effect on infection control practices in hospitals , the SENIC study served as an example that rigorously conducted public health research can change the credibility and acceptability of public health interventions and can speed adoption of important programs . It established how , when a public health problem is important enough , a scientifically rigorous population-based assessment can be used to propel the implementation of effective programs . In the future , public health programs are likely to face ever-greater demands for proof of worth and more competition for support , and more SENIC-style studies may be needed .”
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HAI Progress and Reporting
HAI rates are constantly changing , as are the metrics reported out in HAI Progress Reports from the CDC . The 2019 National and State Healthcare-Associated Infections Progress Report represents the latest snapshot on progress toward HAI prevention and control . At the national level , for acute-care hospitals :
• Overall , about 7 percent decrease in CLABSIs between 2018 and 2019
• Largest decrease in NICUs ( 13 percent )
• Overall , about 8 percent decrease in CAUTIs between 2018 and 2019
• Largest decrease in ICUs ( 12 percent )
• Overall , there was a 2 percent increase in VAEs between 2018 and 2019
• Increase observed in ICUs
• Overall , there was no significant change in SSIs related to the 10 select procedures tracked in the report between 2018 and 2019 .
• There was no significant change abdominal hysterectomy SSIs
• About 4 percent decrease in colon surgery SSIs
• There was no significant change in hospital onset MRSA bacteremias between 2018 and 2019
• About 18 percent decrease in hospital onset C . difficile infections between 2018 and 2019
At the national level , the acute care hospital device utilization highlights in this report include :
• Overall , about 3 percent decrease in central line device utilization between 2018 and 2019
• Largest decrease in ICUs ( 3 percent )
• Overall , about 7 percent decrease in urinary catheter device utilization between 2018 and 2019
• Largest decrease in wards ( 7 percent )
• Overall , there was a 3 percent increase in ventilator utilization between 2018 and 2019
• Increase observed in ICUs
As we know , most U . S . healthcare facilities were required to report select HAI data to NHSN in 2019 for participation in various CMS quality reporting programs ( QRPs ); however , on March 27 , an Extraordinary Circumstance Exception ( ECE ) policy to the CMS QRPs was announced and applied to 2019Q4 data due to COVID-19 pandemic response activities . Many facilities across the nation were inundated with COVID-19 cases during the 2019Q4 CMS QRP reporting deadline , so to alleviate some of the burden from facilities , CMS implemented an exception policy where facilities that were unable to report 2019Q4 HAI data to NHSN due to COVID-19 response activities were not penalized .
HAI reporting was in its infancy in the early 2000s , coming into its own around 2008 and reaching its full implementation through 2010 , according to Julie Reagan , PhD , JD , MPH , a public health expert who was involved in the earliest work toward state-mandated infection surveillance and reporting in the U . S .
“ 2008 through 2010 was the greatest movement in the passage of HAI laws due to attention drawn