This is a companion article to the CLP feature, “HAIs Are at Crisis Stage.”
The problem of hospital-acquired infections (HAIs) has been known and studied for several decades, but grasping the full scope of the problem has become increasingly difficult even as our understanding has improved.
A recent casualty of such greater understanding is the terminology and definition related to HAIs, as employed by units of the US Department of Health and Human Services—including the Centers for Disease Control and Prevention (CDC). No longer merely “hospital-acquired infections,” HAIs are now defined more broadly as “healthcare-associated infections.”
CDC’s terminology and definition have changed as the situation surrounding HAIs has become more complex. Patients who acquire HAIs don’t get them exclusively in hospitals; the infections can be contracted in long-term care facilities, rehabilitation facilities, and any number of other treatment facilities—including hospitals.
Some infections that spread in hospitals actually originate in other facilities such as nursing homes and long-term care facilities, says Joen Johansen, head of marketing for Accelerate Diagnostics, Tucson, Ariz. In some such facilities, antibiotic prescribing policies may be more lax, putting patients at risk of developing infections with highly resistant organisms.
Among the organisms of greatest concern are carbapenem-resistant Enterobacteriaceae, Clostridium difficile, multidrug-resistant Acinetobacter species and Pseudomonas aeruginosa, and vancomycin-resistant Enterococci, to name a few. CDC has designated these pathogens urgent and serious public health threats due to their association with high rates of morbidity and mortality—and the limited drug options available for treating them.
“It’s difficult to track where an infection originally occurred,” agrees Kathy Warye, worldwide vice president for infection prevention at Becton Dickinson and Co (BD), Franklin Lakes, NJ. “A patient may pick up an infection in a long-term care facility, become sick, and be transferred to a hospital for treatment. So labeling the infection ‘hospital-acquired’ isn’t necessarily accurate.”
But CDC’s more-inclusive nomenclature is just a small indication of the magnitude of the problem. The rising incidence of HAIs and increasing number of antibiotic-resistant organisms are both, in some sense, consequences of the medical community being victimized by its own success. Thus, CDC’s newer term has become more common essentially because it’s more reflective of the problem.
But whatever terminology is used, there’s no question that HAIs have become enormously widespread, and in some cases, says Warye, impossible to treat.