Transcript for CDC Telebriefing: With improved infection control, how many antibiotic-resistant related infections and deaths does CDC predict could be averted in 5 years?

OPERATOR: Good afternoon.  Thank you all for standing by. Welcome to today’s conference call. At this point all lines are on listen-only for today’s conference until the question-and-answer portion of our call, at which time you will be prompted to press star one on your touch tone phone. Please ensure that your line is on mute, and please record your name and affiliation so that I may introduce you to ask your questions. Our conference is being recorded.  If you have any objections, you may disconnect at this time. I will now turn the conference over to your host, Mr.  Tom Skinner. Sir, you may proceed. 

TOM SKINNER: Thank you, Jill. Thank you all for joining us today for the release of another CDC’s Vital Signs, this one on the estimated effects of a coordinate approach for action to reduce antibiotic resistance infections. Joining us is Dr. Tom Frieden who will provide some opening remarks and he’ll be joined to answer your questions by Doctors Mike Bell and john Jernigan from our Division of Healthcare Quality Promotion. Dr.  Frieden we’ll turn it over to you. 

TOM FRIEDEN: Thanks very much.  CDC works 24/7 to protect the health, safety and security of Americans and today we’re talking about one of the leading threats that we face in this country. Its antibiotic resistance infections and the infection with C. Diff between healthcare facilities when patients are transferred from one facility to another.  Antibiotic resistance occurs when germs are bacteria aren’t killed by the drugs that were designed to kill them.  This is a big problem and it’s increasing in the U.S. now and it’s expensive in terms of lives and in terms of costs. But what today’s analysis describes are things that we can do now to change it.  Inappropriate prescribing of antibiotics adapts infection control mean that serious threats, things like MRSA, C. Diff and what’s called CRE (Carbapenem-Resistant Enterobacteriaceae) are being spread within and across facilities, particularly when patients are transferred. These infections can lead to severe complications including sepsis or death and are often part of unrecognized outbreaks of disease within a community and across healthcare facilities. C. Diff is found commonly in healthcare facilities, hospitals, and nursing homes, and it can be picked up from contaminated surfaces or spread if people don’t wash their hands.  Most C. Diff infections aren’t resistant to antibiotics but when a person takes antibiotics, it destroys the body’s defenses or the good bacteria and allows C. Diff to take over, putting patients at high risk for severe complications, including death.  Antibiotic resistant germs cause more than two million illnesses and at least 23,000 deaths each year in the U.S.  C. Diff in addition to those caused about a half a million illnesses in 2011 and an estimated 15,000 deaths a year. CDC analysis done in collaboration with the Johns Hopkins Bloomberg School of Public Health, the University of Utah and the University of California Irvine School of Medicine clearly shows that we could see many fewer antibiotic resistant infections and much less C. Diff if healthcare facilities and public health staff, public health professionals, work together as a team. For example, five years after the deadly nightmare bacteria CRE enters an area with ten facilities which share patients, the usual approach if we just keep on doing what we’re doing now, there would be 2,000 patients getting CRE, impacting 12 percent of the patients in the area. If a facility does the best it can on its own, the situation gets better. We call this in the analysis, an independent effort.  That would result, instead of 2,000 patients, 1,500 patients. But that’s still not good enough. In fact, no one facility can stop this because the outbreak moves across facilities around a community. When one facility is preventing infections but a second isn’t, transferring patients can re-infect the facility that was at first clear of infections. Lack of coordination puts patients at higher risk. A coordinated approach where facilities work together to prevent infections and let each other know about CRE issues and other drug resistant issues shows far fewer patients at risk. Instead of 2,000 with the status quo or 1,500 going it alone, the coordinate approach gets that number of patients down to 400 patients in this analysis, impacting 2 percent of patients instead of 12 percent of patients. Working together, plainly said, is better than working alone. It makes sense.  We’ve seen this kind of approach work when facilities work with public health and with each other to improve infection control and antibiotic prescribing to drive down healthcare associated infections. Bottom line, we now clearly know not only how bad the problem is, but also what needs to be done and what the benefits will be if we do that. If we take immediate national action with optimal infection control, stewardship efforts, we can prevent more than 600,000 antibiotic resistant and C. Diff infections, prevent 37,000 deaths over five years, and also avert 7.7 billion dollars of direct medical costs due to these infections. Two factors have the biggest impact.  First, public health departments tracking and alerting healthcare facilities to outbreaks in their area and the threat of drug resistant bacteria coming from surrounding facilities; and second, healthcare facilities including hospitals, long-term acute care hospitals, nursing homes and others working together and with public health authorities to have shared infection control actions to stop the spread of drug resistance and C. Diff. We need to think in terms of the whole communities. Facilities which go it alone can’t effectively protect their own patients. Findings from today’s vital signs offers specific actions to turn the antibiotic resistance epidemic around.  These are infections that affect real people across the nation. People’s husbands, wives, parents, relatives, and everyone can be part of the solution. Change at the state level is particularly critical.  Health departments can lead coordination because they can have unique access to data across facility types around the state. If you’re a hospital doing a great job but the hospital across town or the doctor down the street is not doing a good job, your patients are at risk. Not all health departments will be prepared to take on this coordination and we know that. That’s one reason why we’ve requested funds in the fiscal year 16 antibiotic solutions initiative to fund state protection programs in all 50 states and ten large cities to do this work. These funds will also make it possible to find outbreaks sooner, improve laboratory testing, and track antibiotic resistance much better than we can today. But without those investments, we’ll continue to struggle, and patients will continue to get infections that could have been prevented.  State and local health departments are key players. They can identify the healthcare facilities that need more attention, have staff professionals improve connections and coordination among healthcare facilities, and track the antibiotic resistant threats in their region or state. But again, working together is key and we’re also working closely with healthcare facilities, CEO’s, and administrators. They can do a lot when transferring patients, reviewing infection control actions and improving them, establishing antibiotic stewardship programs at their hospitals, getting leadership commitment to join antibiotic resistance prevention activities in the region, connecting with the health department to share data, and making sure that doctors and nurses and pharmacists have access to prompt and accurate laboratory testing for antibiotic resistant bacteria. No one should get infected with C. Diff or a resistant bacteria just because they’re getting healthcare or are in the healthcare facility. The federal government is also stepping up to meet the challenges. We’re implementing activities across many government agencies to address the national action plan for combatting antibiotic resistant bacteria. At CDC we’re tracking outbreaks, monitoring antibiotic use and resistance, improving prescribing guidelines, preventing infections, supporting state programs and also supporting healthcare facilities, healthcare networks, professional and patient organizations to improve the process of making care safer.  This vital signs really is a call to action. If we just stay with business as usual, there will be hundreds of thousands of infections and tens of thousands of deaths that could be prevented. We know what needs to be done and it’s up to congress to support the resources needed to protect Americans and the risk that we could be in a post antibiotic era that undermines many life saving procedures of modern medicine. The proposal in this year’s budget has an increase of 264 million dollars to implement this program and we’re encouraged that there was some increase in the budgeting from congress but we’re hopeful it can be fully funded so we can protect Americans and act now. I’ll stop here. Looking forward to your questions, also apologizing for the quality of the connection.  I’m calling you from West Africa. 

TOM SKINNER: Thank you Dr. Frieden, Jill, I believe we’re ready for questions. 

OPERATOR: At this time if you would like to ask a question, please press star one on your touch tone phone.  Please record your name and affiliation to have your question asked and answered.  Once again, it is star one.  We do ask that you limit yourself to one question and one follow-up.  Once again, it is star one at this time.  Our first question is from Joel Keehn with Consumer Reports.  Your line is open. 

JOEL KEEHN: Thank you.  I was wondering if there’s a way for patients to be alerted if there’s, say, a C. Diff outbreak in a hospital while they’re a patient there or if there is a way for consumers to be alerted if an outbreak occurs in a hospital in their community? 

TOM FRIEDEN: Thank you. I’ll start and then turn it over to mike Bell to add details. One of the things that we’ve done working closely with other parts of the federal government is to put into the CMS hospital compare system the ratings on how hospitals are doing in terms of hospital associated infections. In terms of other issues, Dr. Bell? 

MICHAEL BELL: Sure, thank you for the question. As you know, we work closely with your organization to provide data to make healthcare as transparent as we can. We continue to try to tackle this question about notifying people about outbreaks.  One of the challenges that we have is that there isn’t a clear black and white definition of when there is an outbreak. For some things, for certain organisms we can say that even one is a concern. We’re in the process of working with state health organizations across the country to find a way to bring information about outbreaks to the public as quickly as possible. 

JOEL KEEHN: Thank you

TOM SKINNER: Thank you.  Next question, Jill? 

OPERATOR: Our next question is from Kenneth Moton with ABC News.  Your line is open. 

KENNETH MOTON: Thank you. What’s your timeline on the CDC action plan, and also, is it crucial to have that full congressional funding by the beginning of your fiscal year? 

TOM SKINNER: Dr.  Frieden, are you there? 

TOM FRIEDEN: Yes, I am. We would like to get started as soon as possible. We’re already taking some actions, but we really are limited by lack of resources to roll this out rapidly. We understand that the congressional discussions of the budget are complex, and we are encouraged by the fact that both houses did have some increase for this area. We really hope that when all is said and done, we can get the resources we need to help protect Americans so that people aren’t unnecessarily at risk of getting serious and potentially fatal infection in healthcare facilities. 

KENNETH MOTON:  Thank you. 

TOM SKINNER: Next question, Jill? 

OPERATOR: Our next question is from Rans Pierson with Reuters. Your line is open, sir. 

RANS PIERSON: Hello, Dr.  Frieden, I just wanted to ask you in terms of the infection control practices if you can give us some specifics of what those would entail and also the nature of this coordination when one facility is transferring patients to another facility. What actually happens — what are you able to do in the process to change the outcome? What’s the nature of this coordination, what takes place to prevent the infection from going into another facility? 

TOM FRIEDEN: Thank you.  I’ll start on that question and turn it over to Dr. John Jernigan, the lead author of today’s study, to make further comments.  One of the things that facilities can do is to implement warning systems so that when they transfer a patient who’s got C. Diff or drug resistant bacteria, the hospital or nursing home receiving that patient knows that in advance. I think that’s well worth doing because that way the facility can prepare and isolate the patient in advance before they may spread it to others. Also to review and continuously improve infection control within the facility, including having an antibiotic stewardship program and to get leadership commitment to join legion-wide activities. Dr. Jernigan can speak more about the details and also about some of the places around the country that have done this and given us a sense of what it can accomplish. 

JOHN JERNIGAN: Right.  For example — this is Dr.  John Jernigan. What the coordinated approach allows us to do is to recognize the emergence of a problem early, say in a single hospital in the region, and to alert the hospitals around them to take additional infection control precautions that they might not otherwise take. Sometimes patients can be carriers of these organisms and no one knows because they don’t show up in the routine clinical test. One of the triggers that might be enacted because of this threshold that’s met is to provide additional testing to patients to find out which patients are carriers and if that patient is moving from one facility to another, as Dr. Frieden suggest, there is the opportunity put in place additional infection control precautions such as use of what we call contact precautious, which is the use of gowns and gloves when receiving that patient to prevent spread. There are a number of regions who are making moves in this directions; coordinated approach in the state of Illinois, they have a system in place in which they are made aware of every patient who are identified as being infected with CRE, and these data are place in a central repository such that other facilities when they are admitting patient can query this database can find out if patients coming into their facilities are carriers of these types of germs and for whom they need additional infection control precautious.

RANS PIERSON: Thank you.

TOM SKINNER: Next question, Jill? 

OPERATOR: Next question comes from Maggie Fox with NBC News, Your line is open.

MAGGIE FOX: Thanks very much. I think everybody on this call knows these are measures that people have been calling for 15 years or longer. Why is it taking so long? Are there some things hospitals can do that don’t cost money that they are not doing? My second question is can you talk about the health departments, I think the report mentions that health departments should take a role in coordinating this? Thanks

TOM FRIEDEN: I’ll start and then turn it over to Dr. Jernigan and Dr. Bell to add. I think part of the problem is what’s really identified by this analysis. That even if an individual hospital makes significant improvements, it’s dependent on other hospitals — sorry.  It’s dependent on other hospitals in the area also making improvements.  So going it alone isn’t enough.  In addition, although there have been some improvements, we know that the systems have to be in place, so just urging doctors to wash their hands or use antibiotics without having a systematic approach across the hospital to track and ensure that’s happening just doesn’t result in consistent, sustained improvements.  Dr.  Jernigan? 

JOHN JERNIGAN: Thanks. I think that action at the state level is particularly critical for this approach.  To implement a coordinated approach or at least head in that direction, states need to be able to identify number one, all the healthcare facilities in their area and know how they’re connected with regards to how they share patients. They need additional staff to improve these connections and to help the coordination that needs to happen between the healthcare facilities in their area. They need to develop a communication plan so that information can be smoothly and seamlessly shared. Very importantly, they need to work with CDC to use the data available to them for action to better prevent infections and improve antibiotic use for healthcare. 

MAGGIE FOX: It sounds like a lot of the funding that you’re calling for is for staffers to just do this.  Is that right?

TOM SKINNER: Maggie, You cut out.  Could you repeat that question, please? 

MAGGIE FOX: It sounds like the money that you need, a large amount of the money that you’re calling for would go for staffers, just to pay staffers that would do this kind of work. 

MICHAEL BELL: This is Mike Bell. That’s part of it.  But there’s a large proportion of the investment that goes to laboratory resources at the regional level to give clinicians and health systems rapid access to antibiotic resistant diagnostic information. Then there’s the need not only for staffers at health departments but also for building capacity in one form or another at the ever growing array of healthcare facilities that we’re dealing with. This is very different than the 15 years ago that you described just in the sense that healthcare continues to migrate away from acute care hospitals into ambulatory centers, nursing homes, and a wide range of places that increasingly need assistance to deal with the spread of infections the way they’re seeing them. 

TOM SKINNER: Next question, Jill? 

OPERATOR: It comes from Kari Oaks with Frontline Medical News group. 

KARI OAKS: Hello.  Thanks for having this briefing.  My question has to do with your confidence in the mathematical modelling that was used, sort of looking from the outside it’s easy to see how there’s a series of contingencies and if one assumption is wrong, it seems as though the numbers could be widely off, but I’m imagining that this modeling has been used in other instances and you’re using it with some confidence and I’m wondering if you can give the people some notion of how you arrived at this. 

TOM FRIEDEN:  I’ll start and Dr.  Jernigan may want to add to this. This is a model that’s based on actual experience so it’s not just a guesswork of what might happen but rather takes the experience in real life of several facilities or areas I should say, both facilities and areas that implemented programs of this nature and saw precisely this type of impact. So the model in this case which was done in conjunction with several academic institutions which have worked in this area for some time we think gives a robust result.  Dr. Jernigan? 

JOHN JERNIGAN: Sure.  We had time to work, as I mentioned — as was mentioned with three different academic centers who have extensive experience in antibiotic resistance modeling who had been independently working on this particular problem. We were able to take advantage of one of the models in particular, as Dr. Frieden notes, has been in development over many years, has been extensively peer reviewed and successfully used to model regional experiences with other antibiotic resistant pathogens. I will say that the use of modeling is an important tool.  Sometimes we can’t get the answers we need through traditional epidemiologic study techniques.  To do so would be impossible or potentially not feasible. Even if we did attempt it, there are so many complexities and weaknesses that it might be hard to interpret those results. In those cases such as this, we have choices. We can take no action. We can take action based upon opinions or guesses or use modeling as a tool to provide additional information that we think is valuable in guiding our actions. 

KARI OAKS: Thank you. 

TOM SKINNER: Next question, Jill. 

OPERATOR: The next question is from Tom Corwin with the Augusta Chronicle. Your line is open. 

TOM CORWIN: Thanks for taking my question.  Under the scenario that you put forth where five years after CRE enters a ten facility area you could either have 12 percent of patients getting CRE or 2 percent, when you talk to people in healthcare and you say 2 percent, even with your coordinated approach, they say that’s still pretty bad, 2 percent.  So even with a greater effort, is this still going to be a pretty bad scenario and could we even do better than 2 percent if we tried other things? 

TOM FRIEDEN: Thanks. That’s a great question. Currently this analysis indicates what we think is a best case of what could happen if we were to implement the existing proven interventions effectively throughout an entire community. But part of the request to congress also includes trying to figure out how to do even better by analyzing new ways of reducing infections.  There are some infections that we don’t currently have good tools to reduce.  We would like to develop those. We would like to fund institutions that can do intervention studies where they try something and see what happens. So in all good programs, we work for a continuous improvement approach which will allow us to do better than that. We agree that 2 percent is 2 percent too much but it’s a whole lot better than 12 percent. 

TOM CORWIN: Thank you. 

TOM SKINNER: Jill, we’ll take one more question and then we’ll have Dr. Frieden wrap up our call, please. 

OPERATOR: Our last question is from Elizabeth Aguilera with Southern California Public Radio.  Ma’am, your line is open. 

ELIZABETH AGUILERA: Thank you. Dr.  Frieden, you talked just now in that previous question a little bit about the number but I wanted to know if you could talk a little bit more about — what are you talking about in terms of the difference? Are there specific numbers not just percentage but how many infections could be avoided by having this better coordination and are there any other things that you’re seeing besides this coordination between facilities that might help decrease these numbers? 

TOM FRIEDEN: Absolutely.  Effective implementation of the program as we have outlined would prevent more than 600,000 antibiotic resistant and C. Diff infections and save 37,000 lives and $7.7 billion over five years. So this is very important. I think we’ve had patients and patients’ families coming forward to talk about their experience with C. Diff and drug resistant bacteria.  Their stories are heart wrenching and particularly so because so many of those infections that are occurring now are preventable with a coordinated approach. That means not only telling other facilities about patients who may have an infection before the patient shows up on their doorstep but also about implementing the best practices in both antibiotic prescribing and infection control.  And that’s the bottom line really for this vital signs, that a public health led coordinated prevention approach can much more completely address the emergence of deadly drug resistant bacteria and C. Diff infections. This is something that we simply must do in order to make a difference in the health of our country.  We’re very hopeful that congress will understand how important this is and fully fund the proposal so that we can protect Americans’ health, safety and security.  Thank you all very much. 

TOM SKINNER: Thank you, Jill. This concludes our call. Thanks to all the reporters who participated. A transcript of this call will be made available through the CDC media relations website later this afternoon. Any reporter needing additional information can call the CDC press office at 404-639-3286.  Thank you all once again for joining us. 

OPERATOR: That does conclude today’s conference call.  We thank you all for participating.  You may now disconnect and have a great rest of your day. 

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES