AHRQ Views: Blog posts from AHRQ leaders
Emerging Infections: A National Patient Safety Challenge
Emerging infections are a serious threat to patients and our health care system. Particularly alarming is the emergence of infections caused by bacteria that are resistant to life-saving antibiotics. In the last month alone, news reports have cited the emergence of a new strain of E. coli that shows resistance to colistin, an antibiotic of last resort.
Like our Federal and private sector partners who support the National Strategy and the National Action Plan for Combating Antibiotic-Resistant Bacteria, or CARB, we at AHRQ are focusing on reducing antibiotic resistance and promoting antibiotic stewardship. One of the projects AHRQ is funding this year involves adapting the Comprehensive Unit-based Safety Program (CUSP) to improve antibiotic use and promote stewardship across multiple clinical settings—hospitals, long-term care, and ambulatory care settings. We are working with our partners at the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) on this effort. We have also increased our funding of research to develop better methods and tools that will help physicians and nurses combat antibiotic resistance, conduct antibiotic stewardship, and improve antibiotic use.
We’re also continuing our efforts to prevent dangerous healthcare-associated infections (HAIs) from occurring in the first place. HAIs affect 1 out of 25 hospital patients at any one time; these infections not only increase suffering, but also can lead to severe complications or death. Preventing these infections keeps patients safe from harm and reduces the need for antibiotics. Each infection prevented is one less episode of antibiotic use and one less opportunity for resistance to develop.
As important as CARB efforts are, we should not lose sight of the need to shift clinical culture in general toward a greater emphasis on patient safety. Emphasizing a culture of safety within all settings of care has long been a goal of AHRQ's patient safety work. The American Nurses Association's (ANA) 2016 campaign "Culture of Safety" is a timely reminder of the critical role that nurses have in this effort.
In AHRQ-funded projects like the Comprehensive Unit-based Safety Program (CUSP), nurses as frontline clinicians often play a lead role in unit-wide efforts to prevent infections, as this nurse from a rural Texas hospital explains. The CUSP method is effective because it combines clinical best practices with teamwork and an emphasis on improving the culture of safety. Using the Nurse Manager module, many nurses across the country led teams participating in our project to apply CUSP to Central Line-Associated Bloodstream Infection (CLABSI), which was able to reduce these infections in intensive care units (ICUs) by 41 percent. CUSP also has been used successfully to reduce Catheter-Associated Urinary Tract Infections (CAUTI) in non-ICUs by 32 percent, as shown by published study results involving 926 hospital units in 32 States. Just as was done for CLABSI, AHRQ developed a CAUTI Toolkit, which incorporates a nurse driven protocol. CUSP puts nurses and other frontline clinicians in the driver’s seat, empowering them to improve safety culture and build the capacity to address safety issues.
In addition to CUSP, nurses can rely on a variety of AHRQ's online resources and tools to prevent infections and address antibiotic resistance in hospitals as well as in long-term care and ambulatory care settings. Some of the resources available include the following:
- The Universal ICU Decolonization: An Enhanced Protocol, which outlines a proven approach to decolonize ICU patients and reduce methicillin-resistant Staphylococus aureurs (MRSA) and bloodstream infections
- The Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit, which explains how multidisciplinary teams can tackle emerging CRE infections such as Klebsiella pneumoniae carbapenemase
Fighting emerging infections and preventing HAIs is a team effort, one in which nurses across the country are well positioned to play a leading role. Simply put, the leadership nurses provide as frontline clinicians is essential to reduce harm and make health care safer.