Objective Text: The APTA supports the objective HAI HP2020-2: Reduce the incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections and appreciates the importance of its inclusion. All providers, including physical therapists and physical therapist assistants, should be aware of, and abide by, universal contact precautions when working with a patient who has MRSA. The spread of such infectious diseases put a significant financial burden on health care systems, is detrimental to the integrity and quality of care delivered and negatively impacts the health and well being of patients.

Los Angeles County Department of Public Health on 12/30/2009 8:08:00 PM

Data Source: Recommend using the National Healthcare Safety Network (NHSN) as a data source.

Ohio Department of Health on 12/30/2009 3:17:00 PM

Objective Clarification: Ohio is not an EIP state. ODH lab does not do antimicrobial typing nor do we collect antimicrobial data completely enough to assess this objective. Not all invasive MRSA infections are hospital related.

Anonymous on 12/30/2009 12:38:00 PM

Objective Clarification: The Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology (SHEA) wish to thank you for the opportunity to comment on Healthy People 2020 Objectives for Healthcare-Associated Infections (HAI).

APIC and SHEA support grouping the healthcare-associated infection objectives in their own topic area. We believe this highlights the importance of these objectives, and calls attention to the expanding need to address these infections as part of the Healthy People 2020 goal of improving the health of all Americans.

We also agree with the coordination of these objectives with the metrics and 5-year reduction targets outlined in the HHS Action Plan to Prevent Healthcare-Associated Infections. It is important that national alignment of metrics and targets is achieved in order to best direct resources and improvement efforts. APIC and SHEA also welcome the opportunity to work with HHS to provide feedback and updates as warranted.

APIC and SHEA support the addition of the new objective of reducing the incidence of invasive methicillin-resistant Staphyloccocus aureus (MRSA) infections. We applaud the use of the Centers for Disease Control and Prevention (CDC) as a data source this proposed objectives, in order to use a national database as a standard for measurement development, supporting appropriate direction of resources and improvement efforts.

We suggest that the MRSA reduction objective specifically include both healthcare-associated and community-associated MRSA. Notable improvement in MRSA infection rates must include reduction efforts in all settings, including acute care, dialysis centers, outpatient treatment centers, extended care settings, and the community in general.

APIC and SHEA strongly support highlighting efforts to eliminate HAIs as part of national health promotion and disease prevention objectives by inclusion of a topic area dedicated to this issue in Healthy People 2020. We appreciate the opportunity to provide comments, and we look forward to continuing our collaboration with HHS.

Christine Nutty, RN, MSN, CIC
2009 APIC President

Mark E. Rupp, MD
SHEA President

Anonymous on 12/24/2009 11:11:00 PM

Objective Clarification, Objective Text: This objective should be expanded to encompass all Multi-Drug Resistant Organisms not just MRSA, but also Clostridium difficile, Acinetobacter, and Vancomycin Resistant Enterococcus. MRSA is not the only pathogen causing massive issues in healthcare settings. It also needs to be noted that many of these pathogens are being introduced into the healthcare settings from the community setting.

Mary Andrawis on 12/22/2009 2:46:00 PM

Objective Clarification, Objective Text: While MRSA represents a significant causative organism for HAI, there are several other organisms such as C. difficile and vancomycin resistant enterococcus (VRE) that are well-known causative agents. The Society recommends expanding this objective to more inclusive.

Anonymous on 12/21/2009 5:03:00 PM

Objective Text: Should also include the reduction in multi-drug resistant gram negative pathogens

Anonymous on 12/11/2009 8:47:00 PM

Objective Clarification: I propose that HP 2020 substantiate on the distinguishing the difference between hospital acquired methicillin-resistant Staphylococcus aureus and community-acquired MRSA. This is an important component of this objective because community-acquired MRSA strains have increased and are emerging as causes of bloodstream infections and skin infections which were initially thought to only be important in the hospital/healthcare environment. It will be beneficial to improve the education and awareness to identify these infections early and further to target prevention efforts outside of the hospital setting. This changing epidemiology of MRSA presents a challenge to infection control and must be considered to meet this objective of reducing the incidence of invasive MRSA infections.

"Clinical challenges in addressing resistance to antimicrobial drugs in the twenty-first century."
Septimus EJ, Kuper KM.
Clin Pharmacol Ther. 2009 Sep;86(3):336-9.

"Waves of resistance: Staphylococcus aureus in the antibiotic era."
Chambers HF, Deleo FR. Nat Rev Microbiol.2009
Sep;7(9):629-41.

Anonymous on 12/3/2009 5:21:00 PM

Objective Clarification: I suggest opening this objective to all strains of Staph aureus, not only MRSA. Same data source will apply. Restricting surveillance to oxacillin-resistant strains ignores the larger problem.

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