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New Guidelines on Hospital Infections

CDC Calls on Hospitals, Others to Work Harder to Stop Drug-Resistant Infections
By
WebMD Health News
Reviewed by Louise Chang, MD

Oct. 19, 2006 -- Federal officials today released new guidelines urging U.S. health care facilities to step up efforts to control drug-resistant infections.

The recommendations come amid rising rates of in-hospital infections with bacteria resistant to standard antibiotics.

Hospitals, nursing homes, and other facilities have known for years that health workers often spread the superbugs between patients on their hands and medical equipment.

About 5% to 10% of patients admitted to hospitals acquire one or more infections during their stay.

Experts warn that resistant bacteria force doctors to use stronger -- sometimes more toxic --antibiotics to quell infections.

Rates of resistance to the antibiotic methicillin rose from just 2% of common Staphylococcus aureus bacteria in 1972 to 63% in 2004, according to the CDC, which issued the guidelines.

The guidelines urge hospitals and other facilities to prioritize control efforts and to do more to monitor infection rates among patients.

"What we're asking today is simple but not easily achieved," says CDC official John Jernigan.

Infectious disease experts blame overprescribing of antibiotics as the major cause of drug- resistant infections.

Antibiotics are often given preventatively or when doctors suspect an infection.

But the drugs are useless against viral illnesses like fluflu, and overuse breeds stronger and stronger generations of potentially dangerous bacteria.

The CDC guidelines call on hospitals to educate doctors and nurses to use antibiotics conservatively.

Other suggestions are surprisingly basic. Doctors, nurses, and orderlies should be trained to wash their hands every time they enter a patient's room to minimize the risk of transmitting pathogens from other patients, they state.

But experts warn that modifying health practices and policies in thousands of U.S. health care facilities requires a cultural shift.

Achieving the Basics

Will Sawyer, MD, a family physician in Cincinnati says overworked hospitals and nursing homes have a hard time observing basic hand-washing protocols requiring them to scrub up every time they enter a patient's room.

"It's too complicated; it's chaos," says Sawyer, a hand-washing advocate.

He urges programs to make health workers are acutely aware of everyday behavior that can turn them into carriers and transmitters of drug-resistant bacteria. "Am I an eye-rubber, nose-picker, or thumb-licker?" he says.

Groups setting hospital quality standards have begun to include basic infection control practices in their measurements.

Some hospitals already report such results under a MedicareMedicare program tying the reporting to increased payment rates.

But not all hospitals agree to institute standard practices or report on their rates of in-hospital infections.

Charles Denham, MD, who is CEO of HCC Corp., a hospital consulting firm, says Medicare will move as early as 2008 to tie its payments to hospitals' success in controlling the spread of drug-resistant bacteria and other pathogens. "[I] think the handwriting is on the wall," he says.

More than 1,200 facilities have agreed to the standards.

Jernigan said the new CDC guidelines are voluntary; the agency has no ability to enforce them.

But Medicare, one of the world's largest health care financers, could heavily influence hospitals' behavior, says Raymond Wagner Jr., an infection control advocate whose son contracted a life-threatening infection while being treated for a broken arm in 2002.

"When they feel the heat, they will see the light," he says.

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