[Federal Register Volume 87, Number 219 (Tuesday, November 15, 2022)]
[Notices]
[Page 68506]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-24822]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Notice for Public Comments on Healthcare-Associated Infections 
(HAI) National Action Plan Targets

AGENCY: Office of Infectious Disease and HIV/AIDS Policy, Office of the 
Assistant Secretary for Health, Department of Health and Human 
Services, Office of the Secretary, Department of Health and Human 
Services.

ACTION: Notice for public comment.

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SUMMARY: The Department of Health and Human Services' (HHS) Office of 
Infectious Disease and HIV/AIDS Policy (OIDP) in the Office of the 
Assistant Secretary for Health (OASH) announces the draft targets for 
updating the Healthcare-Associated Infections (HAI) National Action 
Plan, Phase 1, Acute Care Hospitals, for public comment. The HHS Core 
Group of the HAI National Action Plan reviewed data pre-pandemic and 
between 2020 and 2021 and developed potential 5-year targets based on 
assumptions that current HAI rates should return to pre-pandemic 
baseline rates within 2 years or within 3 years when determining these 
5-year targets. The HHS HAI NAP Core Group recommends 5-year targets 
assuming a return to pre-pandemic baseline rates within 3 years based 
on two fundamentals: (1) pandemic-related challenges will likely 
persist in upcoming years, and (2) the pandemic has caused major 
strains on the health care system which make a 3-year timeline to 
achieve pre-pandemic Standardized Infection Ratio (SIR) the most 
appropriate choice. The draft targets are below.

DATES: All comments must be received by 5:00 p.m. ET on January 13, 
2023, to be considered.

ADDRESSES: All comments must be submitted electronically to [email protected] to be considered.

FOR FURTHER INFORMATION CONTACT: Chinedu R. Okeke, OIDP, Medical 
Officer at [email protected] or 202-868-8872.

SUPPLEMENTARY INFORMATION: Healthcare Associated Infections (HAIs) are 
infections that patients get while receiving care or treatment, and 
many HAIs are preventable. Modern healthcare employs many types of 
invasive devices and procedures to treat patients and to help them 
recover. Infections can be associated with surgeries and the devices 
used in medical procedures, such as catheters or ventilators and due to 
the transmission of pathogens. HAIs are an important cause of morbidity 
and mortality in the United States and are associated with a 
substantial increase in healthcare costs each year. At any given time 
in the US, 1 out of every 31 hospitalized patients are affected by an 
HAI. HAIs occur in all types of care settings, including acute care 
hospitals, ambulatory surgical centers, dialysis facilities, outpatient 
care, and long-term care facilities. The updates here are for phase 1 
of the action plan, which focuses on acute care hospitals.
    HAIs are a significant source of complications across the continuum 
of care and can be transmitted between different healthcare facilities. 
However, recent studies suggest that implementing existing prevention 
practices can lead up to a 70 percent reduction in certain HAIs. 
Likewise, recent modeling data suggests that substantial reductions in 
resistant bacteria, like MRSA, can be achieved through coordinated 
activities between healthcare facilities in each region. The financial 
benefit of using these prevention practices is estimated to be $25 
billion to $31.5 billion in medical cost savings. Risk factors for HAIs 
can be grouped into three general categories: medical procedures and 
antibiotic use, organizational factors, including risks for pathogen 
transmission, and patient characteristics. The behaviors of health care 
providers and their interactions with the health care system also 
influence the rate of HAIs.
    To provide a roadmap for HAI prevention, HHS released the National 
Action Plan to Prevent Health Care-Associated Infections: Roadmap to 
Elimination (HAI National Action Plan) in 2009 with updates to phase 1, 
acute care hospitals made in 2013 and 2018. In 2020, HHS leadership 
transitioned the HAI portfolio to the Office of Infectious Disease and 
HIV/AIDS Policy (OIDP). To date, OIDP is the lead for the federal 
steering committee and charged with leading the process to update the 
HAI National Action Plan. Due to the COVID-19 pandemic, HHS and 
implementing agencies delayed the process of updating the national 
action plan and indicator targets for HAIs in acute care hospitals due 
to data instability. This proposed update would include new indicator 
targets for certain HAIs in acute care hospitals.

Goals

All Goals Are Five-Year Goals With the Baseline Year Being 2023 and the 
Goal Year Being 2028

 Reduce central line-associated bloodstream infections (CLABSI) 
in intensive care units and ward-located patients by 40% from 2023-2028
 Reduce catheter-associated urinary tracts infections (CAUTI) 
in intensive care units and ward-located patients by 25% from 2023-2028
 Reduce hospital-onset MRSA bacteremia by 40% from 2023-2028
 Reduce hospital-onset Clostridioides difficile infections 
(CDI) by 20% from 2023-2028

    Of note, the previous iteration of the HAI national action plan 
included targets for reducing surgical site infections (SSI). However, 
during the period of 2020-2022, there has been significant data 
instability for SSI due to variable surgical volume related to deferral 
of elective surgeries in hospitals undergoing COVID surges. The HAI 
national action plan Core Group therefore decided not to establish 
targets for SSI at this time.

Information Needs

    HHS seeks to obtain feedback from external stakeholders on the 
following:
    1. Are the draft targets realistic and achievable?
    2. Are there any critical gaps in the draft targets? If so, please 
specify the gaps.
    3. Do you have any concerns about the targets? If so, please 
specify, and describe the concern regarding it.
    Each commenter is limited to a maximum of seven pages.

    Dated: November 2, 2022,
B. Kaye Hayes,
Deputy Assistant Secretary for Infectious Disease, Director, Office of 
Infectious Disease and HIV/AIDS Policy, Executive Director, 
Presidential Advisory Council on HIV/AIDS, Office of the Assistant 
Secretary for Health, Department of Health and Human Services.
[FR Doc. 2022-24822 Filed 11-14-22; 8:45 am]
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