Transcript for CDC Telebriefing: New Vital Signs Report - Making Health Care Safer

OPERATOR: welcome and thank you for standing by. All participants will be on the listen only until the question session. At that time, to ask a question over the phone lines, please press star one and record your name at the prompt. This call is being recorded. If you have any objections, please disconnect it. I’ll turn the call over to your host, Mr. Tom Skinner.

TOM SKINNER: thank you, Victor. Thank you all for joining us today for the release of a new CDC vital signs. This one on the connection between infections get while receiving medical care, called healthcare-associated infections, and what percentage of those are being caused by drug-resistant bacteria. We’re joined today by the director of the CDC, Dr. Tom Frieden. We’re also pleased to have join us, Dr. Peter Pronovost, and that is spelled P-R-O-N-O-V-O-S-T. He’ll be joining us today to discuss the role that clinicians can play in changing the conversation on antibiotic resistance and healthcare associated infections. Dr. Pronovost is most known for his work in promoting checklists in healthcare to protect patients. We also have with us Dr. Clifford McDonald, one of the authors, to help us with your questions. I would like to now turn the call over to Dr. Tom Frieden.

TOM FRIEDEN: Thanks very much. Thank you all for joining us. CDC works 24/7 to protect health, safety and security. This month’s vital signs focuses on the connection between antibiotic-resistant bacteria and healthcare associated infections. The bottom line here is doctors are the key to stamping out super bugs. Antibiotic resistance threatens to return us to a time when a simple infection could kill. The more people who get infected with resistant bacteria, the more people who suffer complications, the more who tragically may die from preventable infections. People getting medical care can get serious infections called healthcare-associated infections, and in fact, on any given day, about 1 in 25 hospitalized patients has at least one healthcare-associated infection that they didn’t come in with. No one should get sick when they’re trying to get well. To help better track and prevent these infections, hospitals report healthcare-associated infections to CDC, not including patient names, just aggregate information or individual information without identifiers, including infections caused by c. Difficile, which causes deadly diarrhea, as well as infections after surgery, infections associated with the placement of catheters or tubes in the bladder or a vein. These infections are bad enough, but even more serious when caused by resistant bacteria.

There is encouraging news here. Doctors, nurses, hospitals, healthcare systems and other partners have made progress preventing some healthcare-associated infections. Today’s vital signs shows that the resistant bacteria we’re most concerned about, that we’ve been warning about for several years are still playing a significant role in central line associated bloodstream infections, surgical site infections and catheter associated urinary tract infections. The reports take a closer look at those infections that we’ve yet to prevent, and identifies what percentage of these are caused by six serious and urgent antibiotic resistant threats plus a seventh, c. difficile.

In hospitals, one in seven catheter and procedure-related infections can be caused by any one of these six antibiotic-resistant bacteria. That number increases to a chilling 1 in 4 in certain specialty hospitals called long-term acute care hospitals that provide treatment for patients who are generally very sick, and stay on average nearly a month or more. So what can we do? It’s more important than ever to prevent patients from getting infections while they’re getting medical care. Those infections are likely to be difficult to treat or even impossible to treat because they’re caused by drug resistant bacteria. Doctors, nurses and other clinicians have proven it’s possible to reduce these. In fact, there have been reductions in central line associated bloodstream infections by more than 50% since 2008.

Dr. Pronovost has played a big role in that reduction, in part, about by empowering doctors and nurses. Recently, we’ve had success driving down other complex challenges such as catheter associated urinary tract infections, between 2013 and 2014. But we need to do much more. We’re working with other federal partners, especially the centers for Medicare and Medicaid services, CMS, to prevent infections in healthcare and use the data that’s reported to target prevention at every level. Today’s vital signs report provides information about how well we’re doing as a nation to prevent infections in healthcare related to catheters and procedures, such as surgery.

We believe that doctors, nurses and other healthcare professionals are key to making more progress preventing these infections. They have the power to change the direction of antibiotic resistance nationally, each and every time they care for their patients. It requires taking appropriate steps every time. Relentless efforts to protect our parents, our children, our husbands, our wives, our friends, when they become the next patient. At CDC, we recommend three critical strategies, doctors, nurses and other healthcare providers need to take with every patient, every interaction, to prevent infections and stop the spread of antibiotic resistance. First is preventing the spread of bacteria between patients. Second is preventing infections related to catheters and surgeries. And third, is improving antibiotic use through antibiotic stewardship. Now I’m delighted to turn it over to Dr. Pronovost to say more about this, and then I’ll close and open up for questions. Peter.

DR. PETER PRONOVOST: Thank you, Dr. Frieden and thanks to the centers for disease control for bringing us today to discuss this pervasive issue of hospital acquired infections. it is in the spirit that i think both humble or hopeful and humble. Hopeful at the progress we’ve made and humble at the work ahead of us. An early target for intervention efforts was infections acquired through central line catheters. This snake like tubing allows clinicians to quickly and effectively deliver lifesaving medications to our patients. But if bacteria managed to get on to the central line, either when inserting the catheter, when changing a dressing or injecting a medication, it could quickly become a bloodstream infection. As Dr. Frieden told you moments ago, these central line infections have fallen 50% between 2008 and 2014. And more than 80% since 1999, when the institute of medicine published “to err is human,” the landmark report commonly regarded as the birth of the patient safety movement in the United States and across the globe. Now, this a huge success for healthcare. One that was only made possible by the collective effort of everyone. Government staff, hospital clinicians, employees, patients and their families. All working together to tackle this preventable problem. It worked because we all believed we could do it and we belonged to a learning community. Yet as we treat these infections, we could sometimes inadvertently place our patients in the middle of yet another crisis.

Antibiotic resistance has been identified by the CDC as an urgent and serious threat to the health of our patients. No hospital is immune from this problem and we all have work to do. Yet i believe that same collaborative and committed effort, that same believing and belonging that helps hospitals across the nation reduce catheter infections could help us address antimicrobial resistance and bacterial infections. At Johns Hopkins Medicine, we look to explore innovations to tackle the inter-connective problems of antimicrobial resistance and healthcare associated infections. We work hard to implement and find easy ways for doctors and nurses to follow the same simple three steps that Dr. Frieden outlined to help protect our patients from antibiotic-resistant infections. Prevent the spread of bacteria. We do this by good hand hygiene techniques, by wearing sterile equipment when inserting lines. Prevent infections before they start. Check catheters frequently, and remove them when you no longer need them. And ask if you actually need them before you even place them. And finally, use the right antibiotics for the right duration. Antibiotics could be lifesaving, and they’re necessary for critically ill patients, especially those with septic shock. These need to be adjusted based on lab results and new information about organisms causing the infections. 48 hours after antibiotics are initiated, take a time-out, and do a brief focused assessment to determine if antibiotic therapy is still needed or if it should be refined. A common mistake we make is to continue vancomycin, a type of antibiotic when there is no presence of MRSA, the prime infection that the antibiotic treats. We often tell our staff at Johns Hopkins if it doesn’t grow, let it go. By working together, hopefully in another five or ten years, we’ll be able to look back and see that we’ve moved the needle, not just on one infection, but on all hospital acquired infections. And I think together, we’ll be able to do that. Thank you, Tom.

TOM FRIEDEN: Thanks very much, peter. These are really great points from the front lines of the battle against drug resistant bacteria and you’ve made so much progress not only there but health facilities around the country to do more. Healthcare professionals, though, need the support of their facility leadership. They can’t accomplish this task alone. That’s why healthcare facilities, CEOs, administrators are a major part of the solution. It’s important that they make a priority of infection prevention, sepsis prevention and antibiotic stewardship. Know your facility’s data and target prevention efforts to assure improvements in patient safety. I want to thank congress for recognizing the urgent need to combat antibiotic resistance. In the current fiscal year, FY-16, congress devoted, invested significant new resources entrusted the CDC and we are now using those resources to step up the fight against the spread of antibiotic resistance by speeding up outbreak detection, response and prevention in every state. By improving tracking of resistance and resistance mechanisms, by supporting novel research to address gaps in knowledge. And by working to improve antibiotic use. The bottom line is that every single one of us will be a patient at some point in our lives. These infections affect people across the United States every single day. Antibiotic resistant infections have the potential to infect and affect any one of us, and all of us can help prevent their spread and be part of the solution. Thanks very much.

TOM SKINNER: Victor, i believe that we’re ready for questions, please.

OPERATOR: Okay, we will now begin the question and answer session to ask questions over the phone lines. Please press star one, make sure your phone is unmuted and record your name at the prompt. Participants will be allowed one question and one follow-up. Our first question comes from Maggie Fox with NBC news. Your line is open.

MAGGIE FOX: Thank you very much. Dr. Pronovost, you are probably aware at the same time of the CDC report, consumer reports is issuing its report on healthcare-associated infections and hospitals, and Johns Hopkins is actually on the list of hospitals that have gotten a very low score in preventing c.diff. Can you talk about why that is?

DR. PETER PRONOVOST: Thanks a lot for that question. Patient safety remains our top priority and we are committed to preventing these very troublesome infections. It requires constant vigilance. We are– we saw the bump in our c.diff infections and we noticed part of that bump was in part due to some of our practices regarding cleaning rooms and the practices of some of our antibiotic prescribing, as Dr. Frieden said. We have really refocused efforts so we now have a tool kit that takes these best practices that the CDC put forth and are implementing them. We implemented the time out procedure, and indeed, we have a CDC sponsored program to help look at this time out in Maryland hospitals. We’ve also developed some new technology, such as looking at computer models to predict sepsis. That is also to say that patient safety has the half-life of epinephrine. If you don’t keep focusing on it continually, we’re at risk, and we are continuing to focus our efforts on this, and are hopeful that our rates of c.diff will go back to where they were previously.

TOM SKINNER: Maggie, do you have a follow-up?

MAGGIE FOX: I do actually, because I’m a little startled to hear both of you talk about some very simple steps that you can take, because in reporting on preventing hospital associated infections, it has become very clear i think to a lot of people that it’s very tedious and multi factorial and there isn’t an easy answer. It requires constant, painful day in and day out vigilance. Can you talk about that?

TOM FRIEDEN: I’ll start and Dr. Pronovost may want to continue. I don’t think those two observations are in conflict. There are clear, simple steps. The hard part is to do them each and every time. In addition, there are some problems for which we need to develop new tools. There are some particular types of organisms and types of infections for which our current tools aren’t optimal. But if you look at something like CRE, a nightmare bacteria carbapenem-resistant enterobacteriaceae, areas that have implemented effective programs have been able to drive them down by more than half, in just a couple of years. The same is true of c.diff. Dr. Pronovost.

DR. PETER PRONOVOST: Yes, and Maggie, may I add to that, because I think your points are really insightful. It does need attention. There are simple things, but sometimes the messages have been over simplified. I’ll share with you is when we did our work, Maggie, the initial response was just hand out checklists and infections will go away. As you know, it’s not that simple. Otherwise we would all be thin and we wouldn’t have these problems. We went into hospitals that had very low bloodstream infections and those that were not able to get low, and to say what differentiated those two. And what we found that it wasn’t one thing, but there were some very specific things that hospitals did. Number one, the leaders declared and committed a goal of zero preventable infections. Number two, they supportcreatinigd enabling infrastructure. They worked with the infection prevention team and quality and safety people to support clinicians. They engaged the clinicians in the work and connected them in pure learning communities. And fourth is they transparently reported and had accountability. So there absolutely are clinical steps and there are checklists and best practices, but it really takes an entire organizational commitment with collaboration with health departments and CDC to make sure that we move the needle on these.

TOM SKINNER: Next question, victor.

OPERATOR: our next comes from Mike Stobbe with the Associated Press. Your line is open.

MIKE STOBBE: Hi, thank you for taking my call. I had two questions. First of all, as we report this and put a number out for the public, i wonder how they interpret it. Dr. Frieden, when you talked about the proportion of HAIs in long-term hospitals, I believe you use the word chilling. What adjective would you use for the 1 in 7 portion seen in general acute care hospitals?

TOM FRIEDEN: I would say it’s deeply concerning. We’re seeing a lot of drug-resistant bacteria. That means that infections will be harder to treat, they’ll be more expensive to treat. And patients are less likely to survive. So this is a very concerning report and particularly so in the long-term acute care facilities.

MIKE STOBBE: And my– thank you. My second question was regarding the difference between general acute care hospitals and long-term care facilities, what are some reasons for those differences, if you look at the table, for example, your nightmare bacteria, CRE, was much higher than MRSA was. Why were they different?

TOM FRIEDEN: I’ll ask Dr. McDonald to add to this, but I would point out that these are sicker patients to begin with. They’re in the hospital for longer periods of time. They’re more likely to have indwelling catheters or be on a ventilator and for all of those reasons, more likely to be on and develop resistance to antibiotic or have organisms that have resistance to antibiotics. There is also the possibility that in some of those facilities, this represents outbreaks or local spread within the facility. Dr. McDonald.

DR. CLIFFORD MCDONALD yes, thank you. I’ll just add to that. Often these patients that come to the long-term acute care hospitals– units of acute care hospitals for a prolonged period before that, and there, they’ve received many antibiotics over many days — [no audio] — threat bacteria even there. We’ve even done a study looking at effects of the antibiotics and what they do is disrupt the microbiome, the natural bacteria that live in and on our bodies. They are a natural defense against a colonization and infection with some of these. And finally, as Dr. Frieden mentioned, they do stay a long time in the long-term acute care facility and may even go back and forth to the acute care facility. That’s another reason why there is special emphasis in preventing transmission in a community. We’ve emphasized that in previous vital signs.

TOM SKINNER: Next question, victor.

OPERATOR: as a reminder to ask a question over the phone lines, press star one and record your name at the prompt. Our next question comes from Maryn McKenna with national geographic.

MARYN MCKENNA thanks for being available to do this. I wanted to springboard off Maggie’s questions about the granular things that facilities need to do and ask sort of a flip side of it. in addition to those everyday actions by existing staff, are there things in this problem that can’t be solved without significant investment and here I’m thinking of things like not having enough isolation rooms for c.diff or not having interoperable electronic health records between the long-term care facilities and acute care facilities or possibly even the, i think you were referring to diagnostics, Dr. Frieden. Can you address that big spending side?

TOM FRIEDEN: So, sorry, I missed some of the question, but I think there are both simple and higher level solutions here. Some of them are as simple as improved hand washing and improved environmental cleaning in hospitals. And use of checklists. Some of them are more complicated with current methods, including things like making sure that all parts of the hospital are aware of the antibiotic resistance patterns of their individual patients, something that can be advanced by using the antibiotic use and resistance module. But some of them will require new tools, as you mentioned, new diagnostics that would rapidly determine whether a patient has an antibiotic, — both an infection and antibiotic-resistant infection. And our challenge is to roll this out across the 5,000 hospitals in this country. That’s something for which we need a multi-year investment. We’ve documented previously that by a multi component intervention we’re able to substantially reduce antibiotic resistance and if we do so, we are likely to prevent hundreds of thousands of hospitalizations, as well as tens of thousands of deaths, and literally, billions of dollars in avoidable healthcare costs. I don’t know, peter, if you would like to say more or cliff.

DR. PETER PRONOVOST: yes, this is peter. A couple of thoughts that really great question, and it’s important to realize that the success we had in catheter infection didn’t happen overnight. It was based on decades of research by the CDC, by NIH, by AHRQ, so we understood what causes these infections, how they spread, what therapies are effective in reducing them and how do we change clinician behavior to implement those therapies. The success built on all of those. And there is work through the CDC epi centers that is trying to now address that for antimicrobial resistance, but we need it faster, so we can implement appropriate checklists. We need to better understand when surfaces are clean and make that very much earlier so we know if the cleaning efforts are effective. You’re spot on. We need to have regional and network information systems so we know what those resistance patterns are in the community hospitals and the long-term care facilities. And be able to link them when these patients often come back to acute care hospitals, and then go back to long-term acute care. So really great points and like so many things in patient safety and infection prevention, science really has to be at the bedrock of all that guides us.

TOM SKINNER: Okay, victor, if there are no more questions, we’ll have Dr. Frieden conclude our call.

OPERATOR: okay. There are no further questions, sir.

TOM SKINNER Dr. Frieden, do you want to conclude our call?

TOM FRIEDEN okay, thank you very much for joining us. I would just like to reiterate the bottom line and give you one other piece of information. We’ll all be patients at some point in our lives and we really call on doctors, nurses, clinicians, people who administer and oversee healthcare facilities as the key to turning the tide on drug-resistant bacteria and protecting patients from the risk of infections, which can all too often be fatal. Before we sign off, I want to mention CDC released an interactive web app on health care associated infections caused by antibiotic resistant bacteria called the antibiotic resistance patient safety atlas. It uses data reported from more than 4,000 healthcare facilities to give national, regional and state map views of superbug drug combinations showing percent resistance over time. You can access it through the CDC vital signs website.

TOM SKINNER okay, thank you, Dr. Frieden and thank you Dr. Pronovost for joining us todays, as well as all the reporters who called in. all the materials from this vital signs report, including those materials that Dr. Frieden just mentioned, will be live on the CDC vital signs website today at 1:00 pm. Reporters who have follow-up questions can call the press office at 404-639-3286 or send an e-mail to media@CDC.gov. Finally, a transcript from this telebriefing will be made available as soon as possible on the CDC media relations website as well. Thanks again for joining us, and this concludes our call.

OPERATOR: Thank you all today for your participation in today’s conference. You may disconnect.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES