Sorry for not getting out news before now, but things have been rather busy since our first organizational meeting on June 2, 2000. Many of you know that the meeting was attended by approximately 200 people from the 305 hospitals throughout the two states. A number of others from industry, state health departments, hospital associations, and other areas were also in attendance (e.g., SC, TN, CA, MD, and DC). Presentations of data supporting the concept on which this partnership is based were made by Dr Bill Jarvis head of Outbreak Investigation in the CDC's Hospital Infections Program and by Dr. Farr, UVA Hospital Epidemiologist. Support of the SHEA Board was voiced by Dr. Dale Gerding President of SHEA, who flew in from Minnesota especially for this meeting. Dr. Richard Wenzel, chair of Medicine at MCV voiced his support. He had helped to collect some of the early data (i.e., from 1978-1980) that without doing active surveillance cultures one can't control spread of antibiotic resistant pathogens in healthcare settings where they easily spread and survive preferentially because of the relatively high prevalence of antibiotic therapy in that setting. Support was also voiced by Dr. Ed Oldfield, Hospital Epidemiologist of Eastern Virginia Medical School, Dr Wes Emmons, President of the Virginia Infectious Diseases Society, and Dr. Jan Rhyne, Governor of the American College of Physicians NC Chapter. During a breakout session 89% of those in attendance said that they felt the data were compelling and wished the effort to go forward, but 70% said that they felt a visit by a hospital epidemiologist and slide presentation similar to the one put on in Richmond would be helpful in convincing their hospital to join.
Since that meeting a grant has been submitted to the CDC's Prevention Epicenters Program to provide an administrative infrastructure to PPP. Word on funding should be available by next month. If fully funded the grant will provide support for hospital epidemiologists from 9 hospitals to assist with recruiting and giving talks to facilities using slides shown at the June meeting and turned into a slide set by the CDC. The same slide set will be made into a PowerPoint version so that it can be e-mailed to all facilities in the two states. The grant also should provide an administrative assistant for PPP at the grant center at UVA and an ICP Coordinator for each state, to be based at UVA and WFUSM. It will also provide coverage for a Ph.D. epidemiologist, computer programmers and a medical economist. A web-based mechanism will be created for PPP to confidentially share data and allow hospitals to see how they are doing with comparison with the rest and how the entire project is doing. Strong letters of support were appended to the grant from all but one of the speakers in Richmond as well as the directors of the 2 state health Departments, the President of NC APIC, Dr Bill Rutala, head of the NC Statewide Program, Dr. Loreen Herwaldt and Dr. Dan Diekema, PEP Investigators from the University of Iowa, who are trying to convince their state to join PPP, and Dr. Trish Perl, Hospital Epidemiologist at Johns Hopkins.
A number of hospitals have since contacted us to let us know that they are joining the effort and others have called or e-mailed to ask for help in the effort to convince their administrators. Large e-mail packages of information have been shared with these facilities. Please let us know if and when your hospital decides to join this growing partnership or if you would like to but need help in the form of a visit by one of the hospital epidemiologists as mentioned above.
PPP will be the subject of presentations at both the VA and NC APIC meetings on October 12 (6:30AM-8 AM, breakfast meeting with supposedly a fancy breakfast being sponsored to benefit PPP by Bard) and October 16 (9:30AM-11AM), respectively. These presentations will include some of the data shown in Richmond and additional discussion about the adequacy of active surveillance culture sampling for different sizes and types of facilities, admittedly the most complex epidemiologic concept involved. It is complex because two hospitals exactly the same size with exactly the same number of ICU beds might need very different numbers of cultures depending upon how much MRSA and/or VRE is there and spreading. PPP will be prepared to assist all who join in making decisions about the adequacy of their sampling.
While science seems to be strongly on the side of this partnership working, the largest hurdle that many see in getting this demonstration project to show that CDC guidelines work is confronting and overcoming the HMO mindset in many administrators minds that any new expenditure is a bad idea. It is clear that this "component cost" approach can be clearly wrong. For example, if one had no infection control program, one certainly wouldn't start one at this time given this mindset. The problem is that investing in an infection control program with intensive surveillance and control activities was correlated with a 32% reduction in overall nosocomial infections in the SENIC Study (Am J Epi 1985) (about the only valid data that we have on what happens with vs. without an infection control program, because the study was done the same way in hospitals across the country). A study published from UVA estimated that because UVA's infection control program met all of the SENIC criteria for an effective infection control program that UVA was probably preventing 32% of infections at the time of publication of SENIC. With this in mind we calculated the cost of our nosocomial infections (using published data on their excess costs), which came to over 5 million dollars per year. This meant that we were probably saving >$2 million per year, which was far more than was being spent (showing the error of the component costs approach). A similar critique of the component cost approach will appear soon in an article that we have in press in the Archives of Internal Medicine regarding the silver foley (first author will be Tobi Karchmer, who is moving her career to Wake Forest from U. Maryland in large part to join PPP). Similarly, because antibiotic resistant infections have been shown in every study that has evaluated this question to cost more than infections due to susceptible strains of the same species, it makes sense that preventing the resistant strains from taking over (which clearly will happen if we take no action) might be cost effective. Every study that has evaluated this question to date has found this to be so. This means that anyone deciding that it would be too expensive to join is not using an evidence-based medicine approach and is certainly not taking the long view of this problem.
Those deciding to join PPP and certified as such by us will be given free alcohol hand hygiene product for a period of two years for every room of their facility (and encouraged to use it!) by a company wishing to support PPP. We will continue to seek other added inducements and keep you posted.