	CDC Has 13 Infection Control and Prevention Guidelines Containing Almost 1,200 Recommended Practices, but Activities across HHS to Promote Implementation Are Not Guided by Prioritization of Practices

CDC has 13 guidelines for hospitals on infection control and prevention,  and in these guidelines CDC recommends almost 1,200 practices for  implementation to prevent HAIs and related adverse events. Most of the  practices are sorted into five categories—from strongly recommended for  implementation to not recommended—primarily on the basis of the  strength of the scientific evidence for each practice. In addition to strength of evidence, an AHRQ study identified other  factors to consider in prioritizing recommended practices, such as costs or  organizational obstacles. Furthermore, the efforts of the two agencies  have not been coordinated. CMS’s and Accrediting Organizations’ Required Hospital Standards Describe Components of Infection Control Programs, and Compliance with These Standards Is Assessed through On- Site Surveys

While CDC’s infection control guidelines describe specific clinical  practices recommended to reduce HAIs, the infection control standards  that CMS and the accrediting organizations require as part of the hospital  certification and accreditation processes describe the fundamental  components of a hospital’s infection control program. The standards are  far fewer in number than the recommended practices in CDC’s  guidelines—for example, CMS’s infection control COP contains two  standards. Furthermore, CMS and the accrediting organizations generally  do not require that hospitals implement all recommended practices in  CDC’s infection control and prevention guidelines. Multiple HHS Programs Collect Data on HAIs, but Lack of Integration of Available Data and Other Problems Limit Utility of the Data

Multiple HHS programs collect data on HAIs, but limitations in the scope  of information they collect and the lack of integration across the databases  maintained by these separate programs constrain the utility of the data. First, although CDC’s guidelines are an important source for  its recommended practices on how to reduce HAIs, the large number of  recommended practices and lack of department-level prioritization have  hindered efforts to promote their implementation. A few of these are required by CMS’s or  accrediting organizations’ standards or their standards interpretations, but  it is not reasonable to expect CMS or accrediting organizations to require  additional practices without prioritization. Second, HHS has not effectively used the HAI-related data it has collected  through multiple databases across the department to provide a complete  picture of the extent of the problem.
Why GAO Did This Study

According to the Centers for Disease Control and Prevention (CDC), health-care-associated infections (HAI)--infections that patients acquire while receiving treatment for other conditions--are estimated to be 1 of the top 10 causes of death in the nation. This statement summarizes a report issued in March and released today, Health-Care-Associated Infections in Hospitals: Leadership Needed from HHS to Prioritize Prevention Practices and Improve Data on These Infections (GAO-08-283). In this report, GAO examined (1) CDC's guidelines for hospitals to reduce or prevent HAIs and what HHS does to promote their implementation, (2) Centers for Medicare & Medicaid Services' (CMS) and hospital accrediting organizations' required standards for hospitals to reduce or prevent HAIs, and (3) HHS programs that collect data related to HAIs and integration of the data across HHS. To conduct the work, GAO reviewed documents and interviewed HHS agency and accrediting organization officials.

What GAO Found

In its March report, which is summarized in this statement, GAO found CDC has 13 guidelines for hospitals on infection control and prevention, which contain almost 1,200 recommended practices, but activities across HHS to promote implementation of these practices are not guided by a prioritization of the practices. Although most of the practices have been sorted into categories primarily on the basis of the strength of the scientific evidence for the practice, other factors to consider in prioritizing, such as costs or organizational obstacles, have not been taken into account. While CDC's guidelines describe specific clinical practices recommended to reduce HAIs, the infection control standards that CMS and the accrediting organizations require of hospitals describe the fundamental components of a hospital's infection control program. The standards are far fewer in number than CDC's recommended practices and generally do not require that hospitals implement all recommended practices in CDC's guidelines. Multiple HHS programs have databases that collect data on HAIs, but limitations in the scope of information collected and a lack of integration across the databases constrain the utility of the data. GAO concluded that the lack of department-level prioritization of CDC's large number of recommended practices has hindered efforts to promote their implementation. GAO noted that a few of CDC's strongly recommended practices were required by CMS or the accrediting organizations but that it was not reasonable to expect CMS or the accrediting organizations to require additional practices without prioritization. GAO also concluded that HHS has not effectively used the HAI-related data it has collected through multiple databases across the department to provide a complete picture of the extent of the problem.