Infectious disease experts at Washington University School of Medicine in St. Louis and Barnes-Jewish Hospital will participate in a new multicenter research network dedicated to assessing, treating and preventing hospital-acquired infections.
“As improved health care has led to extended lifespans, the population of older patients who are more susceptible to hospital-acquired infections has increased,” says Victoria Fraser, M.D., the J. William Campbell Professor of Medicine and co-director of the Division of Infectious Diseases. “We have additional growing patient populations that are vulnerable, including patients with suppressed immune systems and surgical patients.”
At the same time, Fraser notes, new pathogens that are particularly virulent or resistant to antibiotics also have emerged in patients. Two of the most worrisome are methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile.
MRSA most often causes mild skin infections, but it can also result in more serious skin infections, or infect surgical sites, the bloodstream or the urinary tract. Epidemiologists estimate that Clostridium difficile causes nearly 3 million cases of diarrhea and colon inflammation per year.
The Centers for Disease Control (CDC) estimates that each year about 2 million infections are acquired in health-care settings, resulting in about 90,000 deaths and more than $4.5 billion in excess costs.
To support innovative research dedicated to stopping these infections, the CDC has announced $10 million in funding over five years through its Prevention Epicenter program. Washington University and Barnes-Jewish Hospital will receive $300,000 annually for five years. In addition to faculty from the Division of Infectious Diseases, researchers from the departments of medicine, surgery and pediatrics will contribute to the research.
“We’re investing in these Prevention Epicenters because we want to continue to improve patient health,” said Denise Cardo, M.D., director of CDC’s Division of Healthcare Quality and Promotion. “By focusing on some of the most difficult and persistent problems facing health-care institutions today, these epicenters will help make health care safer for everyone.”
The other medical schools and hospitals in the network are the University of Utah, Ohio State University, Rush University/Stroger Hospital of Cook County and Harvard University/Eastern Massachusetts Hospitals.
A primary goal will be to standardize reporting of hospital-acquired infections and the development of antibiotic-resistant strains of pathogens.
“Right now, everyone does surveillance for hospital-acquired infections differently—there’s no uniform system,” Fraser says. “Once we have that system and can get accurate data about the rates of infections and the different types of infections, we can develop improved interventions and measure the cost-effectiveness of those interventions.”
Fraser is also interested in what she refers to as “risk stratifying.” Among other things, this involves incorporating data about patient health and susceptibility in assessments of hospital-acquired infection rates.
Common sense suggests, for example, that a young, healthy person coming in to have a wart removed should have a near-zero risk of hospital-acquired infection, while an older cancer patient on chemotherapy coming in for surgery might have a significantly higher risk, perhaps twenty percent. However, until researchers establish baseline data on what those risks are, they have no objective grounds to determine if efforts to reduce hospital-acquired infections are succeeding or failing.
“We shouldn’t be lumping these people together and averaging it all out,” Fraser says. “We need to carefully look within patient populations and know what infection rates are, and what kinds of infections are occurring in different settings in the hospital.”
Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.