Role of regulatory oversight

As reports of antibiotic resistance and HAIs have multiplied, the world's healthcare community has mobilized resources to respond to these problems. Large-scale surveillance projects, such as NNIS in the US and EARSS in Europe, have provided vital information about the scope of the problem. These alarming data have captured the attention of regulatory bodies. Laws designed to help reduce antibiotic misuse and limit nosocomial infections, thereby improving patient safety, have been enacted or are in the process of being enacted in several jurisdictions.

The strong correlation between increased rates of VRE colonization in Europe and the agricultural use of avoparcin has stimulated action. The agricultural use of avoparcin has been banned, first in Denmark in 1995, then by Germany in 1996, and by all European Union nations in 1997. The beneficial effects of this government-mandated ban have been dramatic. In Germany, for instance, the rate of poultry products testing positive for VRE has decreased from near 100 percent in 1994 to 25 percent in 1997. Correspondingly, human rates of VRE colonization in Germany have decreased from 12 to 3 percent (Swartz, 2002).

While a 1985 CDC report on nosocomial infection control showed that hospitals with four key infection control components - an effective hospital epidemiologist, one infection control practitioner for every 250 beds, active surveillance mechanisms, and ongoing control efforts - could reduce nosocomial infection rates by one-third, not until recently has the government taken a more aggressive approach to regulating hospital safety (Haley et al., 1985). Growing concern regarding nosocomial infections has prompted several US states to consider legislation that would require hospitals to publish their HAI rates. As of July 2005, nosocomial infection "report card" laws have been passed in seven states, and are being considered in an additional 37 (Weinstein et al., 2005; APIC, 2006). Hospital-specific HAI rates depend not only on controllable variables, such as hand hygiene compliance, but also on more intractable factors, such as the severity of illness of a hospital's patient population. Careful consideration of these confounding factors, along with emphasis on process measures (such as monitoring appropriate peri-operative antibiotic prophylaxis rates, and selected outcome measures) may facilitate the equitable application of nosocomial infection report card laws. Although legislating patient safety will prove to be complex, patients should be encouraged that hospitals are addressing this dire problem.

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