A grant led by Anthony Harris, M.D., M.P.H., a professor of public health and epidemiology at the University of Maryland, and funded by Agency for Healthcare Research and Equality (AHRQ), examined whether an intervention – the universal use of gloves and gowns to combat MRSA (Methicillin-resistant Staphylococcus aureus) – could also reduce transmission of antibiotic-resistant gram-negative bacteria, including Acinetobacter, Pseudomonas, E. coli and Klebsiella. These bacteria are a major infection-control concern because they often cannot be treated effectively with existing antibiotics, putting patients at greater risk of serious illness and death.
Dr. Harris’ recent study builds on a 2013 investigation, funded in part by AHRQ and published in JAMA Link to Exit Disclaimer, that found that the intervention of universal glove and gown use in ICUs reduced MRSA acquisition, one of the most common antibiotic-resistant bacteria, by 40 percent. The intervention had no impact on vancomycin-resistant enterococcus (VRE) rates compared with standard recommended use of contact precautions.
Preliminary results from Dr. Harris’ study show that the universal glove and gown protocol did, in fact, lower infection rates for antibiotic-resistant gram-negative bacteria, but not by as large of a margin as the intervention showed for MRSA. The protocol “seems to have an effect for most, but not all organisms. And the effect size depends on the type of organism,” he said.
Taken as a whole, this emerging body of knowledge will allow hospitals to more carefully assess, depending on their ICU infection rates, “whether it’s worth using the universal glove and gown intervention,” Dr. Harris said. The work also provides important information relative to the use of contact precautions.
In addition to helping hospitals better protect patients against specific types of HAIs, Dr. Harris’ AHRQ-funded research is identifying the types of pre-existing medical conditions that put patients at higher risk of developing HAIs.
Using data from hospital diagnostic codes, Dr. Harris found that patients with diabetes, kidney disease, obesity, and other chronic conditions had a higher risk of developing a central line-associated bloodstream infection (CLABSI) or surgical site infection (SSI). He also found that hospital rankings based on these hospitals’ CLABSI and SSI rates would change if these hospital rankings took into account the type of patients these hospitals were seeing based on these chronic conditions. Establishing this connection has important policy implications, because current pay-for-performance efforts reduce payments to hospitals if patients develop an HAI as a result of their care and do not currently adjust for many chronic conditions. Thus, hospitals taking care of more patients with chronic conditions may be unfairly ranked based on current methodology.
Dr. Harris’ current AHRQ-funded project is looking more closely to analyze antibiotic utilization practices across hospitals. He is using data that 550 hospitals submit to the Centers for Disease Control and Prevention to determine which risk factors or conditions are risk factors for increased antibiotic use.
“We want hospitals to be striving to improve performance, but we want them to strive based on rankings of outcome measures that are sound,” he said. Sound rankings will require using more precise outcome measures that can identify and adjust for treating more patients who are more vulnerable to HAIs.
