First, we must adhere to proven practices for infection prevention. Hand hygiene, isolation precautions and the guidelines promulgated by SHEA, the Centers for Disease Control and Prevention and other professional societies serve as the foundation of our current efforts. However, these tools are necessary but insufficient in our current battle against HAIs. We must invest in the medical research and technology that will enable us to identify how our healthcare system can avoid the errors leading to HAIs.
Unfortunately, despite the fact that HAIs are among the top 10 causes of death in the U.S., our scientific knowledge base is riddled with significant gaps. We are in desperate need of deeper levels of understanding regarding the epidemiology, pathogenesis and prevention of these infections. The only way to address these gaps is through broad and multifaceted research. The launch of the Partnership for Patients, along with recent public and legislative interest in reducing rates of HAIs, are signs of an encouraging momentum needed to address and answer important research questions about these infections. Current levels of research funding for HAIs will be inadequate to advance the cause of elimination. Only $18 million in National Institutes of Health funding is directed to HAI prevention. In contrast, more than $2 billion is awarded annually for the investigation of other worthy conditions such as cardiovascular disease and HIV.
Finally, we must enhance our surveillance networks, a critical factor in the detection and control of infectious diseases. A prime example of the need for such a mechanism is a recent study of an extremely antibiotic-resistant bacterium known as carbapenem-resistant Klebsiella pneumoniae in Los Angeles. Last spring, the L.A. County Department of Public Health voluntarily chose to monitor for this bacterium in its hospitals and nursing homes, despite the widely held belief that the infection was limited to the East Coast. Through the use of mandatory lab reporting of CRKP when found during testing, county officials discovered startlingly high rates of the germ, particularly in long-term acute-care hospitals. L.A. County health officials are to be commended not only for monitoring and reporting the presence of CRKP, but for providing such a lucid example of the critical importance of such action. Had a national surveillance network to identify such infections been in place, CRKP may have been kept in check when it was first discovered in the New York-New Jersey area almost 10 years ago.
Partnership for Patients is a commendable effort that is encouraging to those of us in the field of epidemiology who are dedicated to working toward the elimination of HAIs. Achieving that goal will require the collaboration of health professionals, patient engagement and dedication of resources that are described in the plan. Every healthcare professional would rather be in the position of preventing than treating an infection; this couldn't be truer than in the case of HAIs. One of the things that epidemiology has taught us is that implementing changes and improvements to the healthcare system without understanding and advancing the science behind those changes would have dire consequences. Not only would we fall short of the worthy goals of improving patient safety, ensuring high-quality care and reducing medical costs, but we would leave ourselves poorly equipped to face the emerging threats that lie ahead.
Dr. P.J. Brennan is chief medical officer of the University of Pennsylvania Health System, Philadelphia. Dr. Neil Fishman is associated chief medical officer of the system. Both are past presidents of the Society for Healthcare Epidemiology of America.