Changing Policies to Strengthen Infection Prevention: An Exclusive Interview with Carissa Holmes, MPH

In an exclusive interview with Contagion®, Carissa Holmes, MPH, Centers for Disease Control and Prevention (CDC), discussed her presentation at the Society for Healthcare Epidemiology of American (SHEA) 2017 Spring Conference where she provided her audience with some insight into how government and regulatory processes impact infection prevention.

Contagion: How can we use policy change to prevent healthcare-associated infections and antibiotic-resistant infections? Why work on policy change in the first place?

Holmes: Policy is a powerful tool. We have seen great progress in health outcomes through policy change—policies that encourage healthy choices and environments—such as smoke-free air laws that dramatically reduce secondhand smoke exposure. There are opportunities to learn from these policies to improve patient outcomes, for example by making healthcare-associated infection (HAI) and antibiotic resistance (AR) prevention and control a system-wide expectation.

Policy is shaped at both the federal and state levels and includes legislation passed and signed into law, and regulations adopted after public comment. In recent years, we have seen accelerated action in adopting policies to prevent HAIs and address AR infections at all levels of government.

Partnerships are essential to ensure that the policies we implement are driven by the science and what actually works to protect patients. These partnerships include healthcare providers, healthcare facilities, and healthcare administrators; state and local public health systems; federal agencies, such as CDC, CMS [Centers for Medicare & Medicaid Services], and FDA; and a range of professional organizations. Together, public health and healthcare partners can support the work of policymakers to craft policies that improve healthcare quality.

C: What are the new infection prevention and antibiotic stewardship regulatory expectations for surveillance and reporting of infections in acute and long-term care settings that clinicians need to be aware of?

H: Regulatory expectations for surveillance and reporting change frequently, and are guided by not just the federal government (e.g., CMS), but also by a variety of approaches at the state level. For example, as of March 2017, 35 states and Washington, DC require public reporting of at least one type of HAI. Many use CDC’s National Healthcare Safety Network for this reporting, which is also used by CMS for payment incentives to reduce HAIs (e.g., value-based purchasing). These different policies can work together to give healthcare providers, facilities, and public health experts the data they need to target prevention and improve the quality of care.

Public health experts, healthcare providers, and policymakers can ensure that policies are guided by scientific evidence and reflect what we know works to prevent infections.

In a rapidly changing policy environment, clear communication between federal and state policymakers, public health experts, healthcare providers, and professional societies can help shape better policies that produce better outcomes for patients.

C: How could reporting or surveillance have a negative impact on an institution and patient outcomes overall?

H: Negative reports can lead to financial penalties for institutions, as well as harm reputations. Nonetheless, meaningful surveillance helps healthcare facilities asses the progress they have made to prevent infections and identify where they need to target prevention efforts to ensure patient safety and improve quality for everyone. It is in everyone’s best interest to make sure public health and healthcare share the best possible surveillance data so we can work together to implement what we know works to improve prevention and patient care.