I have repeatedly written about the vital need to stop one-size-fits-all approaches to complicated medical conditions and health policy as well as how important regional nuance is to solving these and more issues like healthcare-associated infections (HAIs). Identifying the unique interactions, behaviors and exposures of a community drives the en vogue "population health" trend from a patient perspective while optimizing the culture, complexity and effectiveness of local institutions and personnel.
So, when I recently attended the Committee on Reducing Infection Deaths forum of public health leaders, it was refreshing that the representative from the Centers for Disease Control and Prevention (CDC) recognized the highly integrated nature of patient sharing between institutions on a district level as a strategic opportunity to combat spread of disease. Consequently, their data collection and analysis is rightly aimed to make a dent in healthcare-associated infection deaths. That's the best way to identify and fix the problems at their source and better than yet another temporary band-aid.
John Jernigan, M.D., M.S. is the director of the Office of HAI Prevention Research and Evaluation of the Centers for Disease Control and Prevention (CDC)’s Division of Healthcare Quality Promotion (DHQP). He spoke of his efforts to concentrate on a regional approach to controlling HAIs and multi-drug resistant organisms (MDROs). It is his contention it is not a problem individual facilities can solve by themselves.
Instead, it is due to the "dense network of patient sharing" between healthcare institutions and infected patients that we have "reservoirs for transmission." Understanding that connectedness will help create new methods to minimize the spread due to patient sharing -- hospitals more highly connected have higher infection rates. By generating "a matrix of inter-facility patient sharing"--e.g. using Medicare billing data, they then "can merge the data to see how" it "relates to infection rates."
According to Dr. Jernigan, by "characterizing the drivers of outbreaks over time, we can then determine prevention efforts." In addition, a longer length of hospital stay contributes significantly to the problem. Though the goal is to promote prevention everywhere, it is also important-- especially if resources are limited-- to target those facilities where stays are traditionally protracted. Long-term studies are currently underway in Chicago and Orange County to see if we can diminish MDRO rates.
He says the science is relatively early, so we will need to adapt but concludes with "think regionally when thinking of control of antibiotic resistance." (See his Morbidity & Mortality Weekly Report here).
Often times belief in the medical sphere falls short of practical solutions because we dismiss the realities of competing and conflicting drivers in clinical practice and among overburdened care givers. Obviously some facilities navigate the gap between policy and practice more successfully than others and that is what he means about them not doing it alone. We need to get out of isolated bubbles so less well-equipped ones can learn how to be better, and learn best practices. True data sharing between healthcare facilities-- especially on county levels-- is a lofty aspiration but it definitely will deliver meaningful advances in reducing infection deaths, antibiotic resistance and avoidable disease.
The CDC is to be commended for taking the evidence-based approach.