Back from Society for Healthcare Epidemiology (SHEA) Spring 2018.
Thank you for the generous comments, tweets and feedback on my SHEA lecture titled Hospital Acquired Infections: How Much Is Preventable and How Hard Should We Try? Too kind.
So how much can we prevent and how hard should we try?
Hospital acquired infections (HAIs) result in significant morbidity, mortality and cost- obligating us to act.
The soundbite of "getting to zero" was initially explored here by my colleague Mike Edmond. Infection prevention science is inexact. Even high quality studies have limitations, infection prevention processes are inconsistently implemented and practices can can be controversial (contact precautions for endemic pathogens). Further, diagnostic strategies (test stewardship) and gaming can lead to inexact HAI incidence and false conclusions about preventability. Human beings are chaotic systems and do not always respond to linear interventions.
Perhaps up to 75% of HAIs are potentially preventable when focusing on modifiable by risk factors.
We should relentlessly strive to minimize ‘potentially
preventable’ HAIs as this is consistent with the Hippocratic oath of primum non nocere.
We should seek practical (satisfice) solutions for the real world with reliable implementation of known risk reduction interventions. In doing so we must leverage information technology to assist with HAI surveillance/prevention and advocate for sound process measures and reporting policies. Implementation science must be prioritized. HAI strategy decisions should be evidence driven and based on cost/benefit as much as feasible.
Last, we must be clear on expected HAI outcomes- specify what we can and cannot control.
Don't oversell yet aim for zero potentially preventable infections.
