Becker's Clinical Quality & Infection Control

21 W ith infectious diseases like MERS and Ebola arriving in the U.S., and CMS enacting major fines on hospitals with high levels of in- fections, infection control practices in the nation's hospitals and around the globe garnered much attention in 2014. The following is a breakdown of five major infection control occurrences that affected U.S. hospitals in 2014, presented in no particular order. MERS imported to the U.S. While Middle East Respiratory Syndrome, or MERS, really made headlines in 2012 when it was first reported, it did not make its way to the U.S. until 2014, when two cases were diagnosed in May — one in Indiana and one in Florida. Both patients were healthcare workers who lived and worked in Saudi Arabia, according to the Centers for Disease Control and Prevention. MERS is a potentially fatal disease that is transmitted from person to person in close contact. Therefore, healthcare workers caring for patients, as well as members of an infected person's family, are at high risk of contracting the disease, but MERS represented a "very low risk" to the general public, ac- cording to the CDC. However, hospitals that dealt with the illness uncovered some lessons for future dealings with similar infectious diseases. For instance, Munster, Ind.- based Community Hospital, where the nation's first MERS case was diag- nosed, contained the disease with the help of technology as well as by follow- ing established best clinical practices. Neither the Indiana case nor the Florida MERS case resulted in any transmis- sion of the virus, according to the CDC. In December 2014, a study in the American Journal of Infection Control iden- tified infection control gaps as the reason MERS spread in the documented cases of healthcare-associated transmission in Saudi Arabia. Ebola in West Africa and the U.S. With little argument, Ebola was the biggest healthcare story of 2014, as the largest outbreak of the disease in history continues in West Africa. The world- wide healthcare industry has learned several lessons from the outbreak that has claimed more than 7,800 lives through Dec. 27, 2014. The U.S. healthcare industry specifically has learned from the outbreak as well, especially after two healthcare workers from Texas Health Presbyterian Hospital in Dallas contracted the illness after treating an Ebola patient, show- casing weaknesses in the country's overall strong healthcare infrastructure. The spread of Ebola in the U.S. led to new CDC regulations as well as in- creased awareness of the need for clinician training for diagnosing and con- taining infectious diseases. Additionally, 35 U.S. hospitals were designated as Ebola treatment centers in December, meaning they have the capability, training and resources to provide care to an Ebola patient with minimal risk to healthcare workers. Medicare fines for HAIs, readmissions Last year was unprecedented in terms of Medicare payment cuts for hospitals with high infection and readmission rates. The Patient Protection and Af- fordable Care Act established the Hospital Readmissions Reduction Program to penalize hospitals for high readmission rates — in 2014, 2,610 hospitals were penalized under the program. Additionally, the PPACA established the Hospital-Acquired Conditions Re- duction Program, which punishes hospitals for having high rates of certain infections, like central line-associated bloodstream infections, catheter- associated urinary tract infections and other patient harms. For fiscal year 2015, 721 hospitals will see Medicare payment cuts due to high rates of those HACs. Antibiotic resistance advances The World Health Organization released a report in April 2014, titled "Anti- microbial resistance: Global report on surveillance" that included a startling realization: "A post-antibiotic era — in which common infections and minor injuries can kill — far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century." The CDC estimates that 2 million people are infected by antibiotic-resistant bacteria annually, and 23,000 will die due to such an infection. A number of issues contribute to the growing resistance to antibiotics, including overpre- scription of antibiotics and the lack of investment in developing new antibi- otics by much of the pharmaceutical industry. However, strides have been made in the industry to develop new antibiotics. The U.S. Food and Drug Administration approved four new antibiotics in 2014, including two from Cubist — making this the first time this century a company delivered two FDA-approved antibiotics in a single year. Vaccinated illnesses make a comeback 2014 saw a resurgence of diseases that had been mostly eradicated in the U.S. due to vaccines — namely, whooping cough, measles and mumps. The U.S. saw more mumps in 2014 than in years past: Through Aug. 15, 2014, 965 people had been reported to have mumps, compared to just 438 in the entire year in 2013, according to the CDC. One of the more high-profile out- breaks of mumps happened in the National Hockey League, as the disease infected several hockey players on different teams and even some referees. Some NHL teams took steps to quell the spread by offering mumps vaccines to players. Two doses of mumps vaccine are 88 percent effective at preventing the disease, according to the CDC. Whooping cough is another disease with an available vaccine that saw many cases in 2014. California had the bulk of the nation's whooping cough cases, as 9,935 cases were reported in the state from Jan. 1 to Nov. 26, 2014. The state's Department of Public Health attributed much of the epidemic to few- er people getting vaccinated for whooping cough. Finally, measles made a comeback in 2014, as there were 610 confirmed cases of the measles reported to the CDC from Jan. 1 to Nov. 29 last year, the high- est number of measles cases since measles were eliminated in the U.S. in 2000, according to the CDC. The majority of people who get measles are unvac- cinated for the disease. Researchers recently looked into why some parents hesitate or refuse to vac- cinate their children and found insufficient communication from healthcare providers and agencies about the importance and safety of vaccines is largely to blame. n Infection Control in the US: 2014 Year in Review By Heather Punke

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