	CDC Had 13 Infection Control and Prevention Guidelines Containing Almost 1,200 Recommended Practices, and HHS’s Action Plan Includes Some Prioritized Practices to Promote Implementation

In March 2008, we reported that CDC had 13 guidelines for hospitals on  infection control and prevention, and in these guidelines CDC  recommended almost 1,200 practices for implementation to prevent HAIs  and related adverse events. Most of the practices were 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. However, these  steps were not guided by a prioritization of recommended practices. The  department subsequently established the Steering Committee for the  Prevention of Healthcare-Associated Infections, with senior-level  representation of HHS offices and operating divisions, to develop the HHS  Action Plan. CMS’s and Accrediting Organizations’ Required Hospital Standards Described Components of Infection Control Programs, and Compliance with These Standards Was Assessed through On- Site Surveys

In March 2008, we reported that while CDC’s infection control guidelines  described specific clinical practices recommended to reduce HAIs, the  infection control standards that CMS and accrediting organizations require  as part of the hospital certification and accreditation processes described  the fundamental components of a hospital’s infection control program. The standards were far fewer in number than the  recommended practices in CDC’s guidelines—for example, CMS’s  infection control COP contained two standards. Although  CMS and the accrediting organizations generally did not require that  hospitals implement all recommended practices in CDC’s infection control  and prevention guidelines, we reported that the Joint Commission and  AOA had standards that required the implementation of certain practices  recommended in CDC’s infection control guidelines. Multiple HHS Programs Collected Data on HAIs, but Lack of Integration of Available Data and Other Problems Limited Utility of the Data

In March 2008, we reported that multiple HHS programs collected data on  HAIs but that limitations in the scope of information they collected and the  lack of integration across the databases maintained by these separate  programs constrained 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 hinder 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. For example, work by AHRQ suggests factors  such as costs or organizational obstacles that could be considered. Second, we reported that HHS had not effectively used the HAI-related  data it had collected through multiple databases across the department to  provide a complete picture of the extent of the problem. The recently released HHS Action Plan identifies strategies that are  intended to address some of the reasons for the lack of effective actions to  control HAIs, including some identification of priorities from among the  1,200 recommended practices, and plans to coordinate HAI-related data  collection activities across HHS. HHS released the Action Plan for  comment in early January 2009, with the intent of revising it based on the  public input it received. Following the transition to the new presidential  administration, HHS has continued to solicit public comments on the plan  with no designated deadline for submissions. Consequently, it remains  uncertain when or if the new administration will choose to implement this  plan, and if so, with what modifications, to address our recommendations  and reduce the serious problem of HAIs.
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. The statement GAO is issuing today summarizes a March 2008 report, 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 and accrediting organization officials. To update certain information for this statement, GAO reviewed relevant HHS documents released after GAO's March 2008 report.

What GAO Found

In its March 2008 report, which is summarized in this statement, GAO found that 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 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 had 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 had not effectively used the HAI-related data it had collected through multiple databases across the department to provide a complete picture of the extent of the problem. Subsequent to GAO's report, HHS established a steering committee, with senior-level representation of HHS offices and operating divisions, to develop the HHS Action Plan to Prevent Healthcare-Associated Infections. This plan includes strategies that are intended to address some of the reasons for the lack of effective actions to control HAIs, including some identification of priorities from among the 1,200 recommended practices, and plans to coordinate HAI-related data collection activities across HHS. HHS released the Action Plan for comment in early January 2009, with the intent of revising it based on the public input it received. Following the transition to the new presidential administration, HHS has continued to solicit public comments. Consequently, it remains uncertain when or if the new administration will choose to implement this plan, and if so, with what modifications, to address GAO's recommendations and reduce the serious problem of HAIs.