A new paradigm for infection prevention programs: An integrated approach

• Published in: Infection control and hospital epidemiology 2023-01, Vol.44 (1), p.144-147
• Main Authors: Weber, David J., Sickbert-Bennett, Emily E., DiBiase, Lauren M., Brewer, Brooke E., Buchanan, Mark O., Clark, Christa A., Croyle, Karen, Culbreth, Cynthia M., Del Monte, Pamela S., Goldbach, Sherie, Hendrickson, Lori, Miller, Pamela B., Schnell, Natalie A., Schultz, Katherine M., Selimos, Amy, Stancill, Lisa, Summerlin-Long, Shelly K., Teal, Lisa J., Thompson, Sharon C.
• Format: Article
• Language: English
• Subjects: Antibiotic resistance; Catheters; Councils; Data mining; Departments; Disease control; Disease prevention; Ebola virus; Education; Epidemics; Hospitals; Infectious diseases; Influenza; Information technology; Laboratory methods; Letter to the Editor; Medicaid; Medical laboratories; Medical personnel; Medical records; Medicare; Microbiology; Nosocomial infection; Nosocomial infections; Outbreaks; Pandemics; Pathogens; Patient safety; Pharmacy; Prevention; Prevention programs; Public health; Staphylococcus infections; Urogenital system; Workforce planning
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2022.94

The scientific foundation for infection prevention was established by the Study on the Efficacy of Nosocomial Infection Control (SENIC) project that demonstrated essential components of effective programs included (1) conducting organized surveillance and control activities and (2) having a trained, effectual infection control physician, (3) having an infection control nurse per 250 beds, and (4) having a system for reporting infection rates to practicing surgeons.1 The SENIC project also reported the growth in the number of hospitals having an infection prevention nurse (from 6% prior to 1970 to 80% in 1977).2 However, by 1996 only 47.6% of facilities has a hospital epidemiologist.3 The initial focus of infection prevention departments was surveillance for HAIs, outbreak evaluations and control, and reduction of device-associated HAIs. In the past 50 years, the spectrum of activities of an infection program has dramatically increased to include the following: (1) surveillance and prevention of multidrug-resistant pathogens (eg, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, β-lactamase–producing gram-negative bacilli, carbapenem resistant Enterobacterales, Candida auris);4,5 (2) prevention of Clostridioides difficile; (3) recognition and mitigation of biothreats (eg, anthrax), and emerging infectious diseases (eg, Ebola SARS-CoV-2); (4) public reporting to multiple agencies rating hospitals; and (5) financial penalties for hospitals by the Centers for Medicare & Medicaid Services for “poor” performance including high HAI rates. Infection prevention programs have access to several new tools to aid in the prevention of HAIs: (1) widespread use of electronic medical records that allow more complete and efficient access to medical records documentation; (2) improved information technologies that allow for data mining, manipulation of large data sets, easier use of sophisticated statistics, and machine learning6; (3) improved microbiology laboratory methods that aid in determining microbe transmission pathways and outbreak investigations (eg, MALDI-TOF and whole-genome sequencing) as well as rapid microbe identification methods (eg, PCR)5,7; and (4) quality improvement methodology that allows a more systematic approach to identifying problems and then implementing evidence-based infection prevention efforts. Based on our experience at the University of North Carolina Medical Center, the advantages of an integrated department ar