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JOHN JERNIGAN: The good news is as was alluded to, is that we are making progress towards
these goals. And that’s very encouraging. Next slide. Just to review with you again,
to reiterate what Rani said the MRSA objective is to reduce healthcare-associated invasive
MRSA infections for the baseline, which was reported through our EIP system of 26.24 infection
per hundred thousand persons to a target of 6.56 infections per hundred thousand persons,
which represents 75 percent reduction. Next slide. If you recall we had intermediate
targets, a 2013 target of a 50 percent reduction in the incidence of healthcare-associated
invasive MRSA infections. And this slide shows the progress to-date through the EIP program
that I mentioned. Again the baseline was 26.24 per hundred thousand persons, and current
through the calendar year 2009 was down to 22.72 infection per hundred thousand persons,
representing a 13.4 percent reduction over a relatively short period of time. So this
is very encouraging, and, in fact, suggests that we are on track here.
Next slide. I will point out through this slide that there are different kinds of invasive
MRSA infections that are associated with healthcare. This shows the different categories. In the
gray part of the pie there that’s labeled 27 percent is the proportion of all invasive
MRSA infections that had their onset in the hospital. But you’ll see there’s a large
piece of the pie, the 59 percent blue part that are also healthcare-associated, but don’t
have their onset in a hospital, rather they have their onset out in the community somewhere,
they may be related to what happens in a hospital or in another healthcare setting but they
have their onset outside. The biggest reductions have been seen in the
hospital onset portion, and that’s good but I show this slide to highlight that we
need to make progress as well in some of these other areas that are equally as important.
And that’s one of the reasons why we need ongoing research both to inform better guidance,
but also better implementation strategies in some of the non-hospital settings to help
us continue to move towards this goal. Next slide. The CLABSI objective that has
been mentioned before, we measure through the National Healthcare Safety Network and
we use a measure that’s called the Standardized Infection Ratio. The Standardized Infection
Ratio actually is a way of controlling for differences in risk of infection across various
unit types, various hospital types, etc. And so this ratio actually controls for that
and it compares the observed HEI occurrence during whatever reporting period you’re
interested in with the predicted occurrence based upon the baseline period rate, so that
our baseline is considered a 1.0 Standardized Infection Ratio from that baseline period
of 2006 to 2008 and any improvement would be represented in a reduction of that, somewhere
below 1.0. And our target ultimately is to achieve a Standardized Infection Ratio of
0.25, which would represent and correspond to a 75 percent reduction.
Next slide. Again the intermediate 2013 target was a 50 percent reduction in CLABSI as measured
through the Standardized Infection Ratio. And you can see from that slide that compared
to the baseline period of 2006 to 2008 the SIR or Standardized Infection Ratio through
calendar year 2009 was down to 0.82, which represents an 18 percent reduction from baseline.
Again suggests that we are well on our way and on track to meet these targets.
Next slide. And finally I met draw your attention to a recent publication through CDC’s morbidity
and mortality weekly reports journal of what we call our vital signs that were centered
around progress for preventing CLABSI that went a little further back then even this
2006 to 2008 baseline. And what that showed is that when we’ve been tracking these rates
in 2001 we’ve seen fully 58 percent fewer bloodstream infections occurring in hospital
ICU patients with central lines in 2009 compared to 2001.
We also because we had detailed information on these infections we’ve observed that
CLABSI is caused by some germs have decreased more than others. Again, that’s important
information to know so that we can look at some other germs and find out what additional
measures can be taken to keep us on target to meet our goals.
We also discovered that many of the CLABSIs occur in hospital wards outside of ICUs in
other areas of the hospital that are non-intensive care units, but also even outside of the hospital
in hema dialysis centers. And we need to continue to refine our prevention recommendations and
strategies for implementation in these areas as well to continue our progress.
But finally I’d just like to sum up by saying we’re making good progress, we need to continue
to be diligent.