IU expert testifies on hospital-acquired infections on Capitol Hill
July 17, 2014
On June 26, an IU School of Medicine expert testified on hospital acquired infections, or HAIs, before a subcommittee of the House of Representatives Science, Space and Technology Committee in Washington, D.C.
Elaine Cox, M.D., professor of clinical pediatrics at the IU School of Medicine and director of infection prevention and a safety officer at Riley Hospital for Children at IU Health, was invited by Congressman Larry Bucshon, M.D., representative for Indiana’s Eighth District, to discuss the impact of HAIs on treatment at Veteran’s Hospitals across the country, as well as the wider healthcare system. Dr. Bucshon, who is a member of the House Science Committee, is an IUSM alumni.
"HAIs are really an issue in any hospital in the United States and probably the world," said Dr. Cox, who also serves as the founder of Riley Hospital's Pediatric Antimicrobial Stewardship Program. "The U.S. has really done a good job of putting accountability in place because device-related HAIs are now nationally reported -- and they've established parameters to instill additional accountability in regard to reimbursement."
Dr. Cox said the opportunity to testify on HAIs developed from her work with a group of healthcare officials on ways to potentially apply new HAI-reduction technologies in the clinical environment through the IUSM Industry Collaboration Portal, a mechanism to encourage connections between IUSM faculty with industry to leverage research successes into entrepreneurial initiatives as well as new products and therapies.
According to Dr. Cox’s comments during the subcommittee hearing, HAIs can include complications such as blood or urinary catheter infections, surgical site infections and ventilator-associated pneumonia. They can also arise in the form of a secondary illness contracted during a hospital stay.
She also noted that HAIs extract high costs physically for patients, emotionally for patient’s families and economically for the U.S. healthcare system as a whole. Every day, HAIs affect for one out of 25 hospital patients across the U.S., equating to about $5-6 million in direct costs and total costs of $30-100 billion per year.
The most effective method to combat HAIs is the use of traditional prevention methods to prevent infection in the first place, as well as the development of new technologies to supplement these efforts, Dr. Cox said. Traditional methods include hand hygiene and use of the device maintenance "bundle concept," a combination of best practices to reduce bloodstream infection rates. New technologies continue to be debated and researched.
"Our latest intervention is house-wide CHG [chlorhexidine gluconate]-bathing and, in the adult hospitals, universal decolonization, which is a way to decrease the carriage of germs on the skin and in the nose," said Dr. Cox of methods used to prevent HAIs at IU Health. "I think we’re seeing some early successes. It's a nationally known intervention, but not everyone's using it."
Some possible new technologies to prevent HAIs include environmental cleaning in the form of filters, different light sources and employing other naturally antimicrobial surfaces in device implants, she said.
“There’s always going to be that human error challenge," Dr. Cox said. "Are there technologies that we can put in place that don’t depend on the human aspect for decision making or situational awareness going to protect the patient? Those technologies are going to take a tremendous amount of study and development before they’re in use. And then to get them widespread and implemented – it’s a monumental task."
In addition to her recent appearance on Capitol Hill, Dr. Cox's experience with government action includes her role co-creator of the “One Test, Two Lives” campaign, which launched in 2009 to increase HIV testing for pregnant women in Indiana and ultimately led to state legislation approving universal HIV testing for expectant mothers in 2012.
Dr. Cox's efforts earned her the honor of being named a 2014 Indianapolis Business Journal Healthcare Hero. But the biggest reward has always been the chance to see her newborn patients survive the disease and go on to lead fulfilling lives.
"I never intended to be an AIDS doctor, but for a non-infected person, HIV has changed my entire life because I've been able to get to know my patients and see how they've persevered and come out successful on the other side despite everything they've gone through." Dr. Cox said. "I will always credit my patients for making me brave."
She also said the opportunity to testify before Congress left her optimistic about the future of research on HAIs, as well as impressed by commitment of lawmakers to the issue, regardless of their political affiliation.
"It was very uplifting about government in a way,” she said.