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 specific clinical  practices for implementation to prevent HAIs and related adverse events. The practices generally 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. Over 500  practices are strongly recommended. Within HHS, CDC and AHRQ  conduct some activities to promote the implementation of recommended  practices, but the activities are not based on clear prioritization of the  practices, which may consider not only the strength of the evidence, but  also other factors that can affect implementation, such as cost or  organizational obstacles. In addition to CDC, AHRQ has reviewed scientific evidence for certain  practices related to HAIs, but 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

The infection control standards that CMS, the Joint Commission, and AOA  require as part of the hospital certification and accreditation processes  vary in number and content among the organizations, and generally  describe the fundamental components of a hospital infection control  program, that is, the active prevention, control, and investigation of  infections. CMS, the Joint Commission, and AOA standards generally do not  require that hospitals implement all recommended practices in CDC’s  infection control and prevention guidelines. CMS, the Joint Commission, and AOA assess compliance with  their infection control standards through direct observation of hospital  activities and review of hospital policy documents during on-site surveys. Multiple HHS Programs Collect Data on HAIs, but Lack of Integration of Available Data and Other Problems Limit Utility of the Data

Three agencies within HHS—CDC, CMS, and AHRQ—currently collect  HAI-related data for a variety of purposes in four separate databases, but  each of these databases presents only a partial view of the extent of the  HAI problem. Each database focuses its data collection on selected types  of HAIs and collects data from a different subset of hospital patients  across the country. Although officials from the various HHS agencies  discuss HAI data collection with each other, we did not find that the  agencies were taking steps to integrate any of the existing data by creating  linkages across the databases such as standardizing patient identifiers or  other data items. Creating linkages across the HAI-related databases could  enhance the availability of information to better understand where and  how HAIs occur. These  are the databases associated with CDC’s National Healthcare Safety  Network (NHSN), CMS’s Medicare Patient Safety Monitoring System  (MPSMS), CMS’s Annual Payment Update (APU) program, and AHRQ’s  Healthcare Cost and Utilization Project (HCUP). CDC officials have produced national estimates of HAIs, but those  estimates derive from assumptions and extrapolations that raise questions  about the reliability of those estimates. 2. Appendix I: Other CDC Activities Designed to Reduce or Prevent Health-Care-Associated Infections

In addition to developing infection control and prevention guidelines and  recommendations, the Centers for Disease Control and Prevention (CDC)  provides leadership in outbreak investigations, surveillance, and  laboratory research and prevention of health-care-associated infections  (HAI).
Why GAO Did This Study

According to the Centers for Disease Control and Prevention (CDC), health-care-associated infections (HAI) are estimated to be 1 of the top 10 causes of death in the United States. HAIs are infections that patients acquire while receiving treatment for other conditions. GAO was asked to examine (1) CDC's guidelines for hospitals to reduce or prevent HAIs and what the Department of Health and Human Services (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 how compliance is assessed, and (3) HHS programs that collect data related to HAIs and integration of the data across HHS. GAO reviewed documents and interviewed officials from CDC, CMS, the Agency for Healthcare Research and Quality (AHRQ), and accrediting organizations.

What GAO Found

CDC has 13 guidelines for hospitals on infection control and prevention, which cover a variety of topics, 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. Over 500 practices are strongly recommended. CDC and AHRQ have conducted some activities to promote implementation of recommended practices, but these activities are not based on a clear prioritization of the practices. Prioritization may consider not only the strength of the evidence, but also other factors that can affect implementation, such as cost and organizational obstacles. In addition to CDC, AHRQ has reviewed scientific evidence for certain HAI-related practices, but the efforts of the two agencies have not been coordinated. The infection control standards required by CMS and hospital-accrediting organizations--the Joint Commission and the Healthcare Facilities Accreditation Program of the American Osteopathic Association (AOA)--describe the fundamental components of a hospital's infection control program. These components include the active prevention, control, and investigation of infections. The standards are far fewer in number than the recommended practices in CDC's guidelines and generally do not require that hospitals implement all recommended practices in CDC's infection control and prevention guidelines. CMS, the Joint Commission, and AOA assess compliance with their infection control standards through direct observation of hospital activities and review hospital policy documents during on-site surveys. Multiple HHS programs collect data on HAIs, but limitations in the scope of information they collect and a lack of integration across the databases maintained by these separate programs constrain the utility of the data. Three agencies within HHS currently collect HAI-related data for a variety of purposes in databases maintained by four separate programs: CDC's National Healthcare Safety Network program, CMS's Medicare Patient Safety Monitoring System, CMS's Annual Payment Update program, and AHRQ's Healthcare Cost and Utilization Project. Each of the four databases presents only a partial view of the extent of the HAI problem because each focuses its data collection on selected types of HAIs and collects data from a different subset of hospital patients across the country. GAO did not find that the agencies were taking steps to integrate data across the four databases by creating linkages across the databases, such as creating common patient identifiers. Creating linkages across the HAI-related databases could enhance the availability of information to better understand where and how HAIs occur. Although CDC officials have produced national estimates of HAIs, those estimates derive from assumptions and extrapolations that raise questions about the reliability of those estimates.