Combating Healthcare-Acquired Infections (HAIs) with Syndromic Infectious Disease Testing

Healthcare-acquired infections (HAIs) pose a serious threat to patient health and safety. The U.S. Centers for Disease Control and Prevention (CDC) has reported that nearly 1 in 17 patients die due to an HAI-related infection each year.¹

Many HAIs are caused by some of the most dangerous antimicrobial-resistant organisms, such as carbapenem-resistant Acinetobacter baumanii and Candida auris, which can increase the likelihood of sepsis and death.² In the interest of patient safety and public health, a swift, accurate diagnosis should be made as soon as possible to help define the right course of treatment. Infection prevention practices, early detection, and infection surveillance can all help mitigate the risk of HAIs and minimize the spread of antibiotic-resistant bacteria.

Healthcare-acquired infections, also called nosocomial infections, are infections acquired in a healthcare-related setting that were not present prior to receiving medical attention. Each year, about 1 in 25 hospital patients in the United States is diagnosed with at least one infection relating to hospital care.³ Any infection caught within a healthcare facility is considered an HAI; however, some types of bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridiodes difficile (C. difficile), vancomycin-resistant enterococci, and norovirus are among the most common.⁴ Once present, infections can be transmitted through person to person contact, especially in areas with the potential for high concentrations of microorganisms.

Although HAIs commonly surface in environments such as acute care hospitals and long-term care facilities, they can sometimes show up after a patient is discharged. Certain risk factors may increase the likelihood of contracting an HAI, such as invasive procedures, severity of illness, not adhering to best practices for infection prevention, and the improper or sub-optimal use of antibiotics.⁵ Many types of HAIs may be prevented or mitigated with measures such as isolation to interrupt risk of transmission of pathogens and standard hygiene precautions.⁶

To help reduce the burden of HAIs, regulatory organizations have initiated programs and guidelines to support infection prevention and management. In 2008, the Centers for Medicare & Medicaid Services (CMS) put limits on reimbursement for the costs of care associated with certain HAIs.⁷ To further promote a standardized process for infection rate reporting and surveillance, the CDC's National Healthcare Safety Network (NSHN) has developed a standardized set of definitions for understanding common HAIs.⁷

The U.S. Department of Health and Human Services (HHS) has also played a regulatory role in developing targets and metrics for properly monitoring HAIs. In October of 2016, HHS released targets for national acute care hospitals metrics under the National Action Plan to Prevent Healthcare Associated Infections: Road Map to Elimination (HAI Action Plan).⁸ The plan utilized data from 2015 as a baseline and was in effect consecutively from 2015-2020. Data acquired during this 5-year term is being analyzed for further improvements for an updated action plan.⁸

There are many types of healthcare-acquired infections (HAIs), some of which are caused by devices used in medical procedures, including catheters and ventilators, or which appear at surgical sites.⁹ The four most common types are Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infections (CAUTI), Surgical Site Infections (SSI), and Ventilator-Associated Pneumonia (VAP).

CLABSI and CAUTI infections both occur as a direct result of medical device insertion. CLABSI infections are defined as a laboratory-confirmed bloodstream infection not related to an infection at another site, that appear within 48 hours after central line placement.¹⁰ CAUTI infections are caused by urinary catheters and can involve any part of the urinary system including the urethra, bladder, ureters, or kidneys.¹¹

VAPs are another type of HAI caused by using a medical device. In cases of VAP, a lung infection develops in an individual who is on a ventilator assisting them with breathing.¹² Importantly, pneumonia patients, including those with VAP, are sometimes incorrectly or sub optimally treated with antibiotics, further contributing to the AMR pandemic.

Surgical site infections (SSI) are post-operative wound infections that occur in the part of the body where the surgery took place. SSIs can either be superficial infections that only involve the skin, or in more serious cases, may involve tissues under the skin, organs, or implanted material.¹³

Unlike common HAIs caused by medical devices or surgery, C. difficle infections usually arise as a side-effect of taking antibiotics.¹⁴ The CDC classifies C. difficile as a major health threat, estimated to cause nearly half a million infections in the United States each year.¹⁵ Other HAIs monitored and tracked by the U.S. Department of Health and Human Services (HHS) include invasive and hospital-onset MRSA.⁸

Pneumonia patients are often overtreated with antibiotics due to the inability to quickly identify the causative pathogen. Diagnostics such as the BIOFIRE^® FILMARRAY^® Pneumonia (PN) Panel can play a pivotal role in finding the right course of treatment in VAP cases. The panel can help healthcare providers make decisions that limit the unnecessary or inadequate use of antibiotics by providing rapid results for 33 relevant targets.¹⁷ This level of detection is also vital to minimizing the emergence of antibiotic-resistant bacteria and fighting infections such as C. difficile.

HAIs, especially those caused by drug-resistant organisms, can be difficult to treat and may lead to sepsis. Immediate medical intervention is needed as quickly as possible to adequately fight sepsis, treat resistant infections, and improve patient outcomes. With the BIOFIRE^® Blood Culture Identification 2 Panel, results can be available in about one hour, supporting the need to administer targeted patient treatment as soon as possible in order to save lives.¹⁸

The BIOFIRE System can play an invaluable role in the detection and identification of HAI pathogens for CLABSI, CAUTI, SSIs, and VAPs, as well as C. difficile infections. Faster results can help healthcare providers achieve shorter length-of-stay for patients, improved antimicrobial stewardship, and better infection control.¹⁹

Effectively combating HAIs requires the deployment of a multi-pronged approach to lessen the disease burden and protect patient health. Kimberly Boeser, PharmD, MPH, BCIDP, infectious diseases clinical pharmacist and antimicrobial stewardship coordinator at the University of Minnesota Medical Center-MHealth suggests that a good strategy for fighting HAIs consists of three main components: nursing-based antimicrobial stewardship interventions, the deployment of rapid diagnostics, and advanced susceptibility testing for newer antimicrobial agents.²⁰