InternationalClinica // October 2010

Global best practices: the key tofighting healthcare-associated infections

William Bishop

THealthcare-associated infections (HAIs) are a growing cause ofconcern for Japanese healthcare providers. William Bishop, chairmanof the HAI/Safety Working Group at the American Medical Devices
and Diagnostics Manufacturers’ Association (AMDD) in Japan,
explains why there is an urgent need to implement global bestpractices for infection prevention

he spread of multi-drug resistantorganisms in hospitals and other
healthcare settings is on the riseworldwide. The recent discovery of multidrug resistant Acinetobacter at Teikyo
University Hospital in Tokyo and a new
type of multi-drug resistant bacterium withgenes for New Delhi Metalo-beta-lactamase
1 at Dokkyo University Hospital in Mibu arefurther examples of the growing problem.
The media response to these discoveries
and subsequent actions by the Japanese
Ministry of Health, Labour and Welfare(MHLW) may help to heighten publicawareness of this growing problem. The
need for enhanced healthcare-associatedinfection (HAI) controls, however, hasbeen of high concern among healthcare
authorities in Japan for some time.
In April 2007, the Medical Law wasamended to require all healthcare
institutions in Japan to implement enhanced
infection control measures. The Ordinancefor Enforcement of the new law included
four core areas: execute hospital infection
prevention guidelines; hold hospital infection
prevention committee meetings; implement
infection prevention training for employees;
and report on the status of infectious disease
incidences. Healthcare institutions in Japan
not implementing these infection prevention
protocols are subject to inspections.
However, should an outbreak occur at a
noncompliant hospital, there is no penalty
other than a reprimand for not adhering to
the practice of good social responsibility.
From April this year, in an effort tostrengthen infection control measuresnationwide, additional payments above
standard medical fees have been provided tohospitals to offset the cost of implementing
enhanced safety and infection controls.
Despite this renewed focus on fighting HAIs,
infection control guidelines remain voluntary,with no established system-wide mandate on
14© Informa UK Ltd 2010

how infections should be prevented, or how
penalties should be enforced if hospitals do
not adhere to prevention protocols.
The World Health Organization has
identified HAIs as a leading cause of
preventable morbidity and mortality,
in addition to naming it an area whereinvestment in preventive measures would
yield significant cost savings and publichealth benefits. The risk of contracting
HAIs is greater for patients in intensive
care units who are treated with medical
devices such as central venous catheters,
ventilators and urinary catheters, aswell as those with open wounds. The
most common types of HAIs are urinary
tract infections, surgical site infections,pneumonia and bloodstream infections.

Bad bugs, no drugs
The three most troublesome formsof bacteria that cause HAIs include
methicillin-resistant Staphylococcus aureus(MRSA), vancomycin-resistant enterococci
and Clostridium difficile. In addition, there
are various multi-drug resistant organisms
for which there may no longer be anadequate therapeutic choice available tophysicians – “bad bugs, no drugs”.
In the US, Europe and Japan an estimatedtotal of six million HAIs occur each year. Of
those, 1.7 million are in the US and result inan estimated 99,000 deaths every year; moredeaths annually than AIDS, breast cancer
and car accidents combined. When theseannual mortality statistics are comparedwith other global threats, HAIs stand out:
• Seasonal influenza: 36,000 deaths inthe US per year
• Pandemic flu: 18,000 deaths
worldwide in 2009
• SARS: 774 deaths worldwide, ever
• “Avian” (H5N1) flu: 300 deaths
worldwide, ever• “Staggering” costs

The economic costs associated with HAIs
are staggering. In the US, HAIs cause
between $28.4-45bn in excess healthcare
costs each year, with the costs for patientswith HAIs six times that of non-infectedpatients. The key driver of these costs is theaverage length of stay in hospitals, which
increases from 4.5 days for patients without
an HAI to over 20 days for cases with anHAI. A review of studies conducted in North
America, Europe, Australia, Asia and SouthAmerica found that the average per-patient
cost for HAIs was just under $14,000. A study
done in Japan in 2008 found that the average
number of days in hospital increased from15 to 81 when a patient contracted MRSA.
The average cost of treatment increasedaccordingly, from $9,500 to $56,700. Thesefigures don’t take into account factors likelost worker productivity or the opportunity
cost of money being siphoned away fromother healthcare initiatives.
The key to success in fighting HAIs,
as demonstrated in healthcare systems
worldwide, is in the implementation of
mandatory standardised infection control
protocols that go beyond hand hygiene toinclude globally proven infection control
strategies:• Screening patients for carriage ofmulti-resistant organisms;• Isolation and contact precautions;• Improved environmental cleaning;• Antibiotic stewardship; and• Optimal management of safetyengineered vascular access devices.
Enhanced infection prevention and antibiotic
stewardship hold real promise in the fightagainst the rise of multi-drug resistantorganisms; however, the under-reported
costs, both human and financial, of HAIs willcontinue unabated until global best practices
in infection control are both mandated andfully implemented in hospitals system-wide
in Japan and elsewhere around the world.
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