— PJ Brennan, M.D.
Chief Medical Officer
Division of Infectious Diseases, University of Pennsylvania Health System
Chair of the Healthcare Infection Control Practices Advisory Committee (HICPAC)
At my first meeting of the Healthcare Infection Control Practices Advisory Committee (HICPAC) in October of 2003, the Committee heard reports on guidelines in development for Sterilization and Disinfection and Isolation Precautions. Both of those important documents had been years in development by 2003 and were still years away from public release. HICPAC’s challenges in bringing those documents to conclusion and release led to the adoption of a more efficient and rigorous evidence evaluation process. Our new methods now posted on the HICPAC homepage have been the result of new thinking, new resources and significant investments and will serve HICPAC and its constituencies well for years to come.
As the Committee worked to finish the Sterilization and the Isolation Precautions guidelines a movement was already afoot that would radically alter our landscape. At my second HICPAC meeting in March 2004, I made an oral presentation on the public reporting of healthcare associated infections (HAIs). Two states, Illinois and Pennsylvania, had recently passed laws requiring the disclosure of HAI data. Outside of those states there was little awareness among professionals that as far as the public reporting of HAIs was concerned the train was leaving the station. By the summer of 2004, two more states had mandates and HICPAC was hard at work on a guidance document. Six years later nearly half the hospitals in the United States are participants by mandate in the CDC’s National Healthcare Safety Network – more than a seven fold expansion in its base. It has become the de facto national public reporting system. The early apprehensions and occasional acrimony that characterized the discussion of this issue have largely been replaced with the realization that all stakeholders – patients, hospitals, doctors and nurses and payors have benefitted from the attention and effort. I am proud of the role that DHQP and HICPAC played in fostering better methods of surveillance and reporting of HAIs and in the leadership it displayed in the early months of this national movement.
Now that the future is here what shall we do with it? I have three suggestions. First, rigorously scrutinize the evidence. Without rigor the data collection, subsequent evidence, and implementation practices will be prone to error. There is no substitute for the careful development of questions, grading of evidence and the establishment of recommendations that answer the key questions. Second, create more evidence. The belief that we know enough to eliminate HAIs today is false. More investment in basic and translational research is necessary if we are to achieve this goal. Third, value collaboration. Healthcare delivery is, more than ever, a team sport. The integration of healthcare epidemiology and infection prevention teams into patient safety programs, the national investment in infrastructure that is beginning, the development of value based purchasing and innovations in practice all demand collaboration if we are to fully realize our potential to enhance the safety of the care we deliver. The elimination of HAIs is within our sight if not yet within our reach.