Vital Signs Telebriefing : What can healthcare providers do to help prevent serious staph infections?

Kathy Harben: Thank you, Kim, and thank you all for joining us today for the release of a new CDC vital signs.  This month’s vital signs is on staphylococcus aureus, better known as staph, a germ commonly found in places where people live, work, and play.  We’re joined today by CDC principle Deputy Director Dr.  Anne Schuchat.  She’ll present the latest statistics on staph infections and staph related deaths.  She’ll also discuss changes in our progress to prevent life threatening staph infections and discuss the need to adjust our approach.  During the q&a period, we’ll also have Dr. Athena Kourtis.  She’s the lead author and she’ll be available for questions.  I’ll turn the call over to Dr.  Schuchat.

Dr. Schuchat: Thank you, Kathy.  Thank you for joining us today to discuss CDC’s vital signs report.  Each month we focus on the latest data about one of the critical health issues facing our nation and what can be done about it.  Patient safety is a CDC priority.  Everyday CDC and health care experts around the world work to prevent infections and stop their spread.  This time last year a vital signs report called on state and local health departments to rapidly identify and stop the spread of unusual resistant genes and the systems that carry them, emerging threats that have yet to become common. But today we’re talking about an infection that’s already all to common, one of the leading causes of deadly infections in health care and in the community, staph.  Staph is so common, almost all of us carry it on our skin.  But staph becomes very dangerous when it gets into the blood.  Staph can cause bloodstream infections, which can lead to sepsis or death.  Staph can also spread within and between hospitals and other health care facilities like nursing homes.  Staph can also spread in communities.  We hope the new data today will refocus the nation’s efforts to protect patients from staph infections.  Today’s report shows that although we’ve made significant progress, more recently this progress has stalled.  We differentiate staph according to resistance to certain antibiotics.  Staph is either methicillin resistant, also known as MRSA, or methicillin susceptible staph also known as MSSA.  All staph can be deadly.  Today, CDC is reporting national rates of invasive infection and death for all staph.  This new data will help drive prevention and stop infections.  We’ve previously reported the rise in staph infections in the community may be linked to the opioid crisis.  In fact, in 2016, 9% of all serious MRSA infections happened in people who inject drugs rising from 4% in 2011.  Healthcare providers should be aware people who inject drugs are 16 times more likely to develop a serious staph infection than those who do not.  When health providers are aware of this connection, they can make sure that all appropriate prevention and control measures are in place.  CDC’s vital signs reported today found that 119,000 people suffered from blood stream staph infections in the United States in 2017, and nearly 20,000 died.  In health care settings, MRSA bloodstream infections decreased by approximately 17% each year between 2005 and 2012.  but our progress slowed after that with no significant change during 2013 through 2016.  With infections that start outside of a health care setting, we found that MSSA that begins in the community may be on the rise.  Our data shows 3.9% increase in community on set MSSA infections each year from 2012 through 2017.  To help prevent the spread of MRSA in health care, CDC recommends several strategies, including contact precautions or wearing gowns and gloves when caring for patients with MRSA and targeting screening of patients who might carry MRSA.  We believe those actions, along with preventing infections in the first place, keeping hands clean, and improving how  antibiotics are used have contributed to the decline in overall staph infections nationally. But inconsistent or declining adherence to these recommendations might also be slowing our progress.  Overall staph trends are based on data from two sources.  CDC’s emerging infections program in six states and two large electronic health record data sets representing more than 400 acute care hospitals.  Findings from both the large population-based EIP assessment and EHRS align and signal important trends. These data are also consistant with the trends in data from the National Healthcare Safety Network, the NHSN, the nation’s largest health care association infection tracking system.  The bottom line is this.  We have prevented many staph infections. But while we’ve made important progress, our data shows that more needs to be done to stop all types of staph infections.  For health care providers and administrators this means prioritize prevention of staph infections and implement programs based on CDC recommendations.  Health care providers and administrators should review their data on an ongoing basis and decide when to add additional interventions if they are not meeting their infection reduction goals.  These additional prevention measures can include reducing the amount of germs people may carry and spread known as decolonization or through special bathing or medication at the times when people are at higher risk.  There are success stories from this type of concerted prevention effort.  Many hospitals are reducing staph infections by fully implementing current recommendations, continuously reviewing their data, and using additional actions tailored to their facilities when needed.  The veteran’s affairs medical centers are one example of great success.  They reduced their overall staph burden by 43% between 2005 and 2017 by implementing interventions to reduce the spread of MRSA and enhancing their adherence to recommended infection prevention practices.  The CDC continues to fund academic and health care investigators working to reduce staph burden in their health care facilities through an antibiotic resistance initiative. Collaborating with CDC, experts nationwide are studying innovative ways to prevent staph infections and are exploring promising strategies to stop the spread of staph and other germs in health care facilities.  Without that renewed commitment to current infection control practices and innovations that identify additional opportunities to reduce infection, staph will kill more people.  The way forward is clear.  Preventing staph infections and their spread should be a priority for health care institutions.  Not only for clinical staff but also for facility leadership.  Health care providers can follow recommended prevention strategies and treat infections rapidly if they occur.  They can educate patients about high-risk periods during their care and ways to avoid getting and spreading staph infections.  Health care providers and community workers can also be on alert for infections among people who inject drugs and help facilitate those people getting the help they need.  And all of us keep our hands clean, cover wounds, and avoid sharing items that can spread infections like towels and razors.  Deadly staph infections still threaten people in the U.S. MRSA and other types of staph are still a threat.  Some progress has been made but not enough, so we call on health care professionals to step up prevention efforts and follow CDC guidelines to protect more patients from staph.

Kathy Harben: Thank you, Dr. Schuchat.  Kim, we’re now ready for questions.

Moderator (Kim): Thank you.  At this time, if you would like to ask a question, please press star one and please record your name when prompted.  If you would like to withdraw the question, you may press star two.  Again, to ask a question, please press star one.  One moment, please, for the first question.

Moderator: The first question comes from Mike Stobbe with the Associated Press.  Please go ahead with your question.

Mike Stobbe: Thank you for taking my question.  Two questions, actually.  Doctor, could you say a little more about why you think — or you all think MRSA’s incidence rate leveled off after 2012?  Also, could you say something about the death rate, the annual death rate for MRSA and MSSA each year? Has that leveled off or is still going down?  What are those numbers?  Thank you.

Dr. Schuchat: Overall, we think that the plateau we’re seeing may be related to reduced use of contact precautions and reduced following of CDC’s recommendations.  We have an exception with the VA, which has continued to see progress, but we think the plateau may be that hospitals and health care providers perhaps have tired of instituting the intensive recommendations.  The trends in fatality suggest that staph remains as fatal as it has been.  We don’t see a drop in the fatality of either MRSA or sensitive staph in terms of the electronic health record data that was looked at.  So we think that while individual hospitals, health care facilities, communities, and certainly the VA. System may be continuing to make progress, the national plateau that we’re seeing probably stems from dropping off in using the intensive recommendations.  A second factor that’s worth considering but which probably doesn’t explain the whole plateau is the importance of injecting drug use associated staph aureus.  We have some hints that community onset staph infections are increasing and we see an increasing proportion of the MRSA infections being related to people who are injecting drugs.  So we think that that national trend we’re seeing with the opioid epidemic and the extensive use of injecting drugs may be an additional burden that’s leading to the plateau.  There’s a couple of different factors going on.  Some getting better, some getting worse and possibly a drop-off in adherence to CDC recommendations.

Moderator: next question.

Moderator: Next question from Jayne O’Donnell with USA Today.

Jayne O’Donnell: Hi.  I’m somewhat new to covering MRSA, but I’m curious, doesn’t this sound serious enough that something should be required rather than recommended when it comes to rule making for hospitals, if they are not doing it on their own?  Some sort of changes in reimbursement or rules requiring certain procedures?

Dr. Schuchat: thanks for that question.  There’s always a balance between intervention and effect, and what we strongly recommend is that everybody use the contact precautions, and that they evaluate their data.  Ideally not just a single facility but a community pulling together the different facilities in the community, long-term care facilities as well as hospitals.  And when declines slow or progress not continuing, we recommend layering on additional measures.  So a place like the VA hospitals that had pretty high rates to begin with instituted a comprehensive set of interventions and are continuing to see progress.  We do think if a facility or community is seeing a plateau that they should add on more steps. we don’t have the data yet to say that everybody needs to do everything all the time, but we do recommend that clinicians consider additional measures for high-risk patients or high-risk circumstances like those in the intensive care unit or people undergoing particular types of higher risk surgery.  So we don’t yet have a one size fits all everybody has to do everything, because we know there’s a balance between lots of recommendations and people actually following them.  But we want people to use their data to make sure that patient safety is respected and that we make these infections decrease.  Next question.

Moderator: Thank you.  Next from Allison Aubrey with NPR.

Allison Aubrey: You’re reporting 2017 numbers, the 20,000 deaths and 119,000 infections, how does is compare to 2015 or 2016 or some prior year.  I know you said they are relatively stable, but can you give us specific numbers from a prior year?

Dr. Schuchat: You know the important part about today’s report is our ability to give these national projections.  That’s a relatively new capacity.  In the past we’ve focused on tracking MRSA intensively and getting rates for MRSA infections, because sensitive staph are so common that that was an extra burden to actually follow that up.  Today’s report includes results from electronic health records where we were able to look at over 400 acute care hospitals and use essentially automated data carefully validated to project these numbers.  We hope in the future to be able to provide trends.  But today’s report doesn’t give you that is this better or worse in terms of the total picture.  We do see very important declines in invasive MRSA infections over time, but we can’t tell you what the trends are in the total because of the sensitive staph.

Allison Aubrey: Do you want to expand on that?

Dr. Kourtis: This is correct Dr. Schuchat, I just want to add, we have published data on MRSA number of cases and deaths in the past. In our previous threat report in 2013 and these numbers are largely consistent with what we see here. We will be publishing another threat report later in the year and we will have updated them on MRSA deaths.

Moderator: next question.

Moderator: the next question comes from Heidi Splete with Internal Medicine News.

Heidi Splete:  hi.  thank you so much for taking my question.  I was wondering whether you had any data on some of the other causes, maybe, of serious infections that are procedure related, such as maybe from surgery or some tools maybe that weren’t 100% clean ,and how the infection might get introduced that way and as far as any recommendations for what hospitals should do to try to improve things from that angle.

Dr. Schuchat: The reports we’re issuing today don’t provide non-staph health care associated questions whether procedure related or not.  Those types of data are available from our national health care safety network hospital system, NHSN.  We don’t have those other data to share.  We have seen improvements in some kinds of procedure-related infections in that other system but we have also seen stalling in selected areas. And we have a set of guidelines for how health care facilities and clinicians can assure that they are preventing the occurrence of central line associated infections or catheter associated infections, et cetera.  It is very important for there to be checklists and consistent adherence across the team that works in facilities, and as you know, the problem in microbial resistance has made preventing healthcare infections even more critical than ever.  Next question.

Moderator: the next question comes from Jennifer Nessel with Pharmacy Times.

Jennifer Nessel: hi.  Thank you for taking my question.  I was wondering if you could speak to the responsibility of prescribers such as health systems prescribers when it comes to being aware of staph infections.  How do you think pharmacists should approach this issue?  Thank you.

Dr. Schuchat: Pharmacists play a very important role in the whole healthcare ecosystem. And as you know, anti-microbial use has been strongly associated with anti-microbial resistance in general.  We actually have some information in the MMWR today from the VA analysis that suggested a decrease in Fluoroquinolone prescriptions in the latter period, which may have contributed to the continued decline in resistant infections that they saw.  So we think that pharmacies play an important role in making sure that patients get good information and working with their facilities on recommended drugs to be used.  We really think the right drug needs to be used at the right time for the right purposes and for the right duration and that that can help us avoid the increases in anti-microbial resistance we’re seeing.  Next question.

Moderator: the next question comes from Steven Johnson with Modern Healthcare Magazine.

Steven Johnson: Hello, hi, thank you for taking my question.  I was curious, the community associated infections, what are some of the major drivers?  Are you saying that drug use has become a major driver in terms of where we’re seeing slight increase in community associated infections? And if not, what are some of the key factors driving that slight increase?

Dr. Schuchat: You know the community onset infections are a complex group.  They include people who probably acquired their infection during a prior hospitalization.  We call them healthcare associated community on set and then others who acquired their infection in the community and had no prior healthcare exposure. We did see some continued drops in health care associated community infections with MRSA that probably relate to these advancements of contact precautions and other means that are going on in the health care setting whereas the community associated infections that had no prior history of health care exposure didn’t see that decrease. And it may be — or they saw a smaller decrease depending on which data system we’re looking at.  It looks like the problem with the opioid epidemic may be part of the reason that we’re seeing that plateau or even increase in the community associated infections.  So a lot of progress over time in different rates with the health care setting through the interventions that we’ve recommended. And not yet a lot of progress in community associated infections potentially worsened by the burden of injection drug use.  But it’s a complicated story.  Next question.

Moderator: as a reminder if you would like to ask a question, press star one and please record your name. The next question is from Jayne O’Donnell with USA Today.

Jayne O’Donnell: hi, I just had a follow-up on my earlier question.  I had been looking more closely a list from CMS of the 50 worst hospitals when it came to MRSA, and some of them were Howard university hospital, hospitals in Baltimore that catered to poor residents of the inner city there. So how can they feel comfortable their hospitals are going to quote, unquote, ensure patient safety, as you said, if there isn’t some sort of requirement that everybody be screened when they walk in the door and like it is elsewhere in other countries?

Dr. Schuchat: the reporting that you’re referencing is a wonderful advance that allows consumers to actually see what’s going on in facilities where they are considering having procedures or being admitted, where their loved ones may be.  We think data access are just a critical opportunity right now for consumer demand to help us improve patient safety all around.  it’s important to know that risk adjustment is done when people are looking at trends and actually absolute rates of infection, because hospitals that see much sicker patients often have a higher rate of complications, because of that patient population that they have. But what we’re looking for over time is improvement from wherever you were to better statistics.  So I think that consumers certainly can talk to their clinicians about what are they doing and what are the procedures in place in their facility and leadership in hospitals we really strongly recommend take patient safety seriously and of course take prevention of staph infections seriously.  We don’t at this time think there’s one size fits all for the decolonization or some of the other steps like screening on admission.  We certainly think it’s worth considering those steps in particular circumstances.

Jayne O’Donnell: And what is your name?  I didn’t get the exact name.

Dr. Schuchat: I’m Dr. Anne Schuchat.

Jayne O’Donnell: You are.  I thought the other person was.  I got you.  Thank you, sorry.

Dr. Schuchat: Sure. Is there a next question?

Moderator: Yes.  Our next question comes from Bara Vaida from Association of Healthcare Journalists.

Bara Vaida: Hi, thanks for taking my question.  I have two questions.  One, there was a mention there was going to be a report later this year about an update on the MRSA infections.  Will that include all antibiotic resistant infections?  The second question is, what do you make of why has there been a drop-off in terms of why would healthcare facilities not be using these precautions?  How do you account for that?  Is there too many regulations?  I don’t understand how these hospitals could have dropped off in precautions.

Dr. Schuchat:  thank you.  Yes, the report that CDC will be issuing later in 2019 will be an update on the full spectrum of anti-microbial resistant threats. So look for that in the future.  I think the reason that adherence to our recommendations have fallen maybe multiple, there may be places where they wonder whether these are having an effect.  There may be places they wonder if it’s worth the trouble.  We think that the results speak for themselves in terms of the impact that they are having, but sometimes at that individual clinician or facility level people aren’t really looking at their data and seeing that. So I think there’s questions clinicians may have about effect and value. But this is a very serious infection, and we think it’s very much worth preventing. Next question.

Moderator: At this time I show no further questions.

Kathy Harben: Thank you very much.  Thank you, Dr. Schuchat and Dr. Kourtis for joining us today.  For follow-up questions, you can call us at the press office 404-639-3286 or e-mail us at media@cdc.gov.  We will post a transcript of this briefing.  Thanks, everyone.  This concludes our call.

Moderator: Thank you for joining today’s conference.  You may disconnect at this time.

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