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HHS seeks comments on prevention of HAIs in LTC

Wednesday August 1, 2012
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The U.S. Department of Health & Human Services has announced the opportunity for public comment about Phase 3 in its five-year "National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination."

A new chapter on long-term care focuses on combating HAIs in nursing facilities and skilled nursing facilities. It extends earlier efforts that focused on acute care hospitals (Phase 1), ambulatory surgical centers and end-stage renal disease facilities (Phase 2) and influenza vaccination of healthcare personnel (Phase 2).

The LTC strategy proposes to expand the activities of multiple federal and nonfederal partners to combat HAIs prevalent in LTC settings, including urinary tract infection, lower respiratory tract infections, influenza and influenza-like illness, Clostridium difficile infection and skin, soft tissue and wound infections.

According to the recommendations, progress should be assessed by tracking resident influenza and pneumonia vaccination rates and the rates of CDI and UTI.

CDI rates have reached epidemic levels among the general population, according to information in the chapter. Hospitalization rates doubled from 2000 to 2005 and the death rate increased fivefold from 1999 to 2004. Hospitalization and death rates are disproportionately higher among people ages 65 and older. In at least one state, more than half of healthcare-associated CDI cases are estimated to appear in nursing homes. The situation is complicated by increased rates of antibiotic resistance among the elderly, potentially making treatment more difficult.

UTI, including catheter-associated UTI, is the most commonly reported and treated infection in nursing homes and skilled nursing facilities. It also is a leading driver of 30-day hospital readmissions from those facilities. As with CDI, UTI treatment can be complicated by past antibiotic treatment, according to the recommendations. Unique diagnostic and management challenges for older patients also add complexity.

The chapter details strategies for addressing these issues. Proposed activities include expanded research, extended application of existing practice guidelines, development of new practice guidelines, provider implementation of national quality improvement initiatives and payment policies that promote infection control and reduction.

To read a PDF of the new chapter, visit http://1.usa.gov/MI9D0N. Comments may be submitted to OHQ@hhs.gov through Aug. 22.


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