Vice President Medical Affairs North America at BD

Before the pandemic, mandatory reportable hospital acquired infections (HAIs) were improving. The Centers for Disease Control and Prevention (CDC) championed theHAI Prevention Bundles that had been implemented across the nation and one of the most at risk for mortality, CLABSI (Central Line Associated Infections and Blood Stream Infections) rates, had significantly improved in the US. Then came the COVID-19 pandemic, and CLABSI and CAUTI (Catheter-associated Urinary Tract Infections) started to rise again. Let’s examine what happened here.

Aside from healthcare professional burnout and surge capacity issues, which can disrupt any quality improvement program, we might give thought to the likelihood that infection prevention efforts, which are critical, are unfortunately not a panacea. Several studies have shown that a certain degree of hospital-associated infections can be preventable. However, few of these studies are conducted during the most stressful times, such as yearly cold and flu season (much less a worldwide pandemic), where the high patient surge will inevitably burden the most ardent of healthcare providers. During such circumstances, clinicians must triage their duties because there is less time to care for more patients. Although this seems glaringly obvious, it is a difficult variable to account for in clinical research and studies.

While The Joint Commission (TJC) and Centers for Medicare & Medicaid Services (CMS) licensing surveys help to (re)establish and give valuable feedback on the importance of HAI prevention bundles at the local hospital level and opportunities for prevention improvement, there are newTJC and CMS required programsdesigned to help HAI initiatives and patients: antimicrobial stewardship. In March 2020, the CMS ruled that antimicrobial stewardship teams are now required as a Condition of Participation. Furthermore, these programs require an expert physician or pharmacy lead connected with infection prevention programs and a committee supported by a hospital quality executive. The central tenet of antimicrobial stewardship teams is to get the right antimicrobial to the right patient in the most efficient, yet safestamount of time. Linking antimicrobial stewardship to infection prevention programs was a necessary step in strengthening our healthcare infrastructure to support infection prevention departments.

"Timely pathogen identification to treatment not only improves patient safety, but also helps to simplify nursing workflows, which is a critical need for every healthcare system today—given the influx of staffing shortages and burnout issues."

How would this new collaboration work from a clinical standpoint? With CLABSI and CAUTI on the rise again, antimicrobial stewardshipteams can pick up the baton where nature has other ideas and infection prevention efforts are either overlooked or overwhelmed. Namely, when an HAI does occur, antimicrobial stewardship can help identify the pathogen and the definitive therapy for the prescribing clinician. Timely identification to treatment not only improves patient safety, but also helps to simplify nursing workflows, which is a critical need for every healthcare system today—given the influx of staffing shortages and burnout issues. CMS recommends that microbiology and laboratory services be represented on the antimicrobial stewardship committee, strengthening micro-laboratory workflows with the appropriate antimicrobial therapy delivered to the patient.

Improving patient care and safety will always be a guiding compass for the CDC and CMS. With resources in healthcare systems constrained, existing programs required by TJC and CMS should be leveraged as a foundational opportunity to develop novel workflows between infection prevention and antimicrobial stewardship programs. And this link will be necessary: at the time of writing, hospital-onset bacteremia and fungemia(HOB) is currently in review as a new quality metric that could build upon the gains made in CLABSI rates but will also heighten the need to address “breakthrough” infections when infection prevention efforts are overwhelmed.

There is no better time to break down healthcare silos and improve collaboration. Today's healthcare systems have the infrastructure and programs in place, and clinicians already intuitively know where the overlap of infection prevention meets antimicrobial stewardship. Clinicians, hospital administrators, medical technology companies, and public health leadersneed to collaborate on the convergence following the patient through Infection Prevention, Identification of infection and Delivery of Definitive therapy. Let us leverage our combined insights across sectors and practices to adapt and change to the new healthcare realities—just as viruses do.

If there is one lesson to be learned from the COVID-19 pandemic, it is that healthcare quality should be inextricably linked to a multidisciplinary team approach to optimize infection prevention, treatment, and patient safety.