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  • Healthcare-Associated Infections

    Healthcare-Associated Infections

    Active surveillance is critical in reducing and preventing the spread of infection

     

     

The growing incidence of HAIs demonstrates the need for reliable surveillance 

Hospital costs directly related to management of healthcare-associated infections (HAIs) are on the rise and the subject of intense focus for managing quality of care and institutional efficiency. 

In high-income countries alone, the cost of HAIs is estimated to be nearly €7 billion annually.1 On top of these financial costs, HAIs can result in:1

  • Prolonged hospital stays
  • Increased resistance of microorganisms to antimicrobials
  • Emotional burden for patients and their families
  • Increased number of deaths 

 

Of all HAIs, Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile (C. difficile) represent the most common bacterial infections, with MRSA/SA and C. difficile infections affecting millions of patients and causing millions of extra days of hospital stay each year. Additionally, the care costs associated with these HAIs top $30 billion annually in the US alone. The substantial human suffering and financial burden of these endemic HAIs prompt an urgent need for healthcare facilities to establish effective surveillance for infection control and prevention.

Microbiology labs are the first lines of defense for detection of HAIs, unexpected pandemics, and outbreaks. By implementing a reliable surveillance program that rapidly and accurately detects colonized patients, clinical microbiology and infection control can help reduce the worldwide burden and spread of these costly infections.

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“Fast and reliable detection of MRSA and C. difficile is essential for rapid diagnosis of infection, choice of adequate antibiotic treatment, and prevention of potentially life-threatening healthcare-associated infections.
Outstanding accuracy and sensitivity combined with short 'time-to-result' intervals position molecular MRSA and C. difficile testing at the top of the list for responsible patient care in the 21st century.”

Dr. Dr. Dr. Martin Ehrenschwender

Dr. Dr. Martin Ehrenschwender,

Institute of Medical Microbiology and Hygiene University Hospital Regensburg

The rising burden of Clostridium difficile

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C. difficile infection (CDI) is responsible for over $1 billion in extra healthcare costs annually in the US.2

CDI, which is known to cause severe diarrhea, pseudomembranous colitis, or toxic megacolon, not only imposes a monetary burden on both healthcare facilities and patients, but also results in prolonged patient suffering. Patients infected with C. difficile may require extended hospital stays, possible re-hospitalization, and additional medications. 

Complicating efforts to manage these costly infections, CDI is changing as evidenced by: increasing virulence, rising incidence, unresponsiveness to metronidazole therapy, and worse outcomes, including death.3 In fact, deaths in the US related to C. difficile increased 400% between 2000 and 2007, in part because of the emergence of hypervirulent strains.4 Additionally, US hospital stays related to CDI tripled in the last decade, further illustrating the growing public health threat of the infection.2

The increased severity and incidence of CDI make accurate and rapid identification of the infection imperative, highlighting the need for reliable surveillance methods to detect outbreaks, and identify and treat patients quickly.3,5

According to the CDC, hospitals that followed infection control recommendations lowered CDI rates by 20% in less than 2 years.Microbiology labs are an essential part of timely and accurate reporting of CDI, enabling clinicians to provide appropriate therapy and improve patient management.

 

Learn more about C. difficile testing › 

 


The rationale for SA and MRSA surveillance

In the US alone, SA and MRSA infections burden the healthcare system with approximately $9.5 billion and $20 billion in annual care costs, respectively. 6, 7

Moreover, these staggering financial figures only capture a fraction of the burden attributed to MRSA and SA infections. Hospitalized patients endure prolonged stays and suffering, resulting in tangible and intangible costs that add to the considerable price tags associated with the increased morbidity and mortality rates due to MRSA/SA infections.

It’s well established that SA is commonly found as part of the normal flora on the skin and in the respiratory tract of 30% of the population without negative effects on the carrier.8 However, up to 93% of hospital-acquired SA infections are caused by a patient’s own colonized flora. 

Colonized patients, specifically, are at increased risk of developing surgical site infections, which lead to prolonged hospital stays, higher costs, and significantly increased risk of death. In fact, SA nasal carriers are 9 times more likely to develop a surgical site infection compared to non-carriers.9 Nasal carriage of SA is also a major risk factor for self-infection in dialysis, ICU, and burn patients.10

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Colonized patients, specifically, are at increased risk of developing surgical site infections, which lead to prolonged hospital stays, higher costs, and significantly increased risk of death. In fact, SA nasal carriers are 9 times more likely to develop a surgical site infection compared to non-carriers.9 Nasal carriage of SA is also a major risk factor for self-infection in dialysis, ICU, and burn patients.10

A surgical site infection related to undetected SA increases:11,12

  • Risk of death by 2.6 times
  • A hospital stay by 12 days
  • Care costs up to $24,890 

A study published in the New England Journal of Medicine demonstrated that programs employing rapid molecular detection of SA colonization followed by targeted decolonization resulted in a 60% reduction in surgical site infections.13

To address the evolving problem of MRSA/SA, growing numbers of hospitals are partnering with microbiology labs to incorporate MRSA/SA screening and surveillance to identify and control these infections.

 

Learn more about MRSA/SA surveillance › 

 

  • Acronyms:

References:

1. World Health Organization. Report on the burden of endemic health care-associated infection worldwide. http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf?ua=1. Published 2011. Accessed April 15, 2014. 

2. Centers for Disease Control and Prevention. Stopping C. difficile infections. http://www.cdc.gov/VitalSigns/Hai/StoppingCdifficile/. Published March 2012. Accessed April 15, 2014.  

3. Peterson LR, Mehta MS, Patel PA, et al. Laboratory testing for Clostridium difficile infection: light at the end of the tunnel. Am J Clin Pathol. 2011;136(3):372-380. doi:10/1309/AJCPTP5XKRSNXVIL.

4. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Published September 2013. Accessed April 15, 2014. 

5. Lessa FC, Gould CV, McDonald LC. Current status of Clostridium difficile infection epidemiology. Clin Infect Dis. 2012;55(Suppl 2):S65-S70. doi:10.1093/cid/cis319.

6. Noskin GA, Rubin RJ, Schentag JJ, et al. Budget impact analysis of rapid screening for Staphylococcus aureus colonization among patients undergoing elective surgery in US hospitals. Infect Control Hosp Epidemiol. 2008;29(1):16-24. doi:10.1086/524327.

7. Saadatian-Elahi M, Teyssou R, Vanhems P. Staphylococcus aureus, the major pathogen in orthopaedic and cardiac surgical site infection: a literature review. Int J Surg. 2008;6(3):238-245. doi:10.1016/j.ijsu.2007.05.001.

8. Centers for Disease Control and Prevention. General information about MRSA in healthcare settings. http://www.cdc.gov/mrsa/healthcare/index.html. Published September 2013. Updated April 2014. Accessed April 15, 2014.

9. Critchley, IA. Eradication of MRSA nasal colonization as a strategy for infection prevention. Drug Discov Today Ther Strateg. 2006;3(2):189-195. doi:10.1016/j.ddstr.2006.05.003.

10. Yu VL, Goetz A, Wagener M, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. N Engl J Med. 1986;315(2):91-96. doi:10.1056/NEJM198607103150204.

11. Engemann JJ, Carmeli Y, Cosgrove SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis. 2003;36(5):592-598. doi:10.1086/367653

12. Anderson DJ, Kaye KS, Chen LF, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE. 2009;4(12):e8305. doi:10.1371/journal.pone.0008305.

13. Bode LGM, Kluytmans JA, Wertheim HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med. 2010;362(1):9-17. doi:10.1056/NEJMoa0808939.