"I am also the victim of a hospital-acquired infection(s) and had no idea how easily one could go from relatively good health to feeling lucky to survive," Anne told UPI's Caregiving. "I was released from a Washington-area hospital after about two weeks of ups and downs, trying to fight off sepsis. My instructions were to return to the hospital if my temperature exceeded a certain level. The first night home, my temperature went above that level, but I feel confident that, if I had returned, I would never have gotten out again."

Anne said she felt her body could concentrate on fighting off the infection better at home, without being exposed to new pathogens.

"I was determined never to return to that hospital again, only to see my second-choice hospital portrayed on national television ... as the likely source of the infection that killed a healthy young mother who contracted meningitis and died within a short time of entering the hospital to deliver her first baby."

There is a debate raging within the medical community on how to address the ever increasing incidence of HAIs. Some say follow the example of Denmark and other European countries that have HAIs of less than 1 percent, while other say that more study is needed and that more aggressive methods of infection control should only be used when needed, while some object to the extra cost that might not achieve the desired HAI drop.

The trouble is no one is really defining what the HAI rate should be, and there is no real federal regulatory agency to force the issue -- neither the CDC nor the Joint Commission is a regulatory body.

The CDC can only make recommendations, and the Joint Commission looks at HAIs as part of the accreditation process, but while it requires that all hospitals have systems for reporting infection surveillance, prevention and control, mainly it ensures a program is in place.

While most agree the goal is to lower the HAI rate, there is no stated national goal -- one hospital may feel reducing its HAI rate by 10 percent is a noble effort, while The University of Pittsburgh Medical Center -- comprised of numerous hospitals -- reduced its infection rate by 80 percent in several intensive care units.

One doctor said his hospital was a few percentage points higher than the HAI national average, which many thought was pretty good and not worth the extra trouble of lowering.

However, this infectious-disease physician told Caregiving that he enacted the Society for Healthcare Epidemiology of America, or SHEA guidelines, and implemented a program that had good hand hygiene, required IVs be inserted into patients using antiseptic procedures, implemented active surveillance of infections of high-risk patients and isolated infected patients -- and he got his intensive care unit HAI rate down to less than 1 percent.

In 2000 the SHEA board of directors made reducing antibiotic-resistant infections a strategic SHEA goal, and two years later a SHEA task force drafted an evidence-based guideline on preventing nosocomial (hospital) transmission of pathogens, focusing on methicillin resistant Staphylococcus aureus, or MRSA and Vancomycin-Resistant Enterococcus.

The CDC has recommended for a long time to isolate colonized (infected) patients with these types of pathogens; however, while many facilities have this as stated policy, they do not actively identify colonized patients via surveillance cultures, known as active surveillance. As a result, many colonized patients remain undetected in hospitals and nursing homes and can infect others, according to SHEA.

SHEA says that active surveillance is essential to identify the infected patients to make infection control possible, according to Infectious Control Hospital Epidemiology.

The debate over infection control is generally between those who favor the SHEA guidelines and those who don't.

"To do active surveillance for MRSA -- there is a fair amount of scientific debate amongst those who argue against active surveillance and isolation because by isolating a patient in a room by themselves and having staff add cap, mask and gown every time they have to enter the room can actually result in adverse outcome because the patient is visited less often," Dr. John Jernigan, an epidemiologist for the CDC, told Caregiving.

There have been some hospitals that have been able to significantly reduce infection rates by not using active surveillance and isolation, and some say the downside to active surveillance and isolation is the extra expense and the need to change the hospital culture -- from the head of the hospital to the cleaning staff -- and some frontline healthcare workers don't believe their actions have an impact on microbes, according to Jernigan.

Alex Cukan is an award-winning journalist, but she always has considered caregiving her primary job. UPI welcomes comments and questions about this column.

Next: The CDC to release new infection control guidelines

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