The Journal The Authority on Global Business in Japan


February 2014

Strengthening Regional Frontline Infection Prevention and Control
APEC leaders take action to build regional capacity

By William R. Bishop, Jr.

Since the Asia–Pacific Economic Cooperation (APEC) First Senior Officials’ Meeting, held in Sendai in September 2010 during Japan’s host year, ACCJ Healthcare Committee members working with like-minded partners throughout the region have been instrumental in helping to drive the success of the APEC Healthcare-associated Infection (HAI) Initiative.

APEC held the first High-level Workshop on Healthcare-associated Infections in Manila in July 2012. As an outcome, regional economies agreed to take three initial steps to begin reducing the huge economic burden of HAIs: invest in infection prevention and control policies and programs; enhance data collection and surveillance; and encourage partnerships and collaborations to help tackle the HAI burden.

“HAIs add to the functional disability and emotional stress of the patient and may, in some cases, lead to disabling conditions that reduce the quality of life.

“The economic costs of this menace are considerable. The increased length of hospital stays for infected patients is the greatest contributor to its costs. Prolonged stays not only increase direct costs to patients and payers but also indirect costs due to lost work,” said Enrique Ona, secretary of Health for the Philippines, at the Manila workshop.

APEC held the second High-level HAI Workshop in Medan, Indonesia, in July 2013. This focused on the economic cost burden of HAIs and best-practice sharing region-wide including the creation of a set of principles for ethical public–private partnerships.

The meeting concluded with a set of recommendations calling on regional economies to recognize the economic and public health burden of HAIs and to commit to working with regional stakeholders to reduce, by 2015, the incidence of infections in healthcare settings by establishing surveillance systems, baseline measurements, and targeted reduction goals at the economy and local levels.

When most business leaders and policymakers think about infectious disease, they tend to focus on emerging antibiotic-resistant diseases or infectious diseases associated with potential pandemics. Indeed, this is why billions of dollars are being spent in Japan, China, and the rest of Asia to build or strengthen national disease control and prevention centers to monitor potential public health threats.

According to Pricewaterhouse-Coopers’ 2012 APEC CEO Survey, pandemic risk ranked among regional CEOs’ top three concerns, nearly equal to a sharp spike in oil prices above $150 per barrel or a major disruption of the internet or cyber attack.

It is easy to understand why pandemic risk is such a concern when the potential costs to regional trade, travel, and tourism are considered. The U.S. General Accounting Office estimates the SARS crisis (November 2002–July 2003) cost Asian economies $11 billion–$18 billion, with country losses of 0.5 percent–2 percent of total output.

Two important lessons were learned from the SARS crisis: the value of a coordinated regional and international response to successfully track and contain SARS, and the actions that stand today as instructive examples of multinational cooperation.

Though often overlooked, there was an important third lesson; about 40 percent of SARS infections were acquired inside healthcare facilities—a stark reminder of the importance of fundamental frontline infection prevention and control.

The World Health Organization (WHO) has identified HAIs as a leading cause of preventable disability and death, and an area where investment in preventive measures would yield significant cost savings and public health benefits.

In many ways HAIs are a kind of global, endemic pandemic in that these infectious organisms already reside in most healthcare facilities worldwide. Patients acquire HAIs while receiving treatment for another condition in a healthcare facility.

Examples of common HAIs include pneumonia, bloodstream infections, surgical site infections, and urinary tract infections. Patients who are hospitalized—especially those in critical care—are at constant risk of developing these infections, which require specialized treatment and lead to longer hospital stays.

Healthcare02.14The WHO estimates that HAIs affect hundreds of millions of patients annually worldwide. Based on a comprehensive literature review conducted in 2011, the WHO believes there are more than 4 million patients in Europe affected each year by HAIs and 1.7 million in the United States. This leads to 99,000 deaths annually in the United States alone.

Even in high-income countries, about 30 percent of patients in ICUs are affected by at least one episode of a HAI. However, in developing countries it was found that there is a troubling lack of comprehensive national data on HAIs.

In low- and middle-income countries, as reported in available studies, the incidence of ICU-acquired infection is at least two- to three-fold higher than in high-income countries. Further, device-associated infection is up to 13 times higher than in the United States.

The economic costs associated with HAIs are staggering. To fight these infections, patients who develop them require significantly more and higher-cost resources, estimated to be up to six times greater than those of non-infected patients.

The monetary benefits of HAI prevention in the United States alone range from $5.7 billion to $31.5 billion and are likely greater in less developed APEC economies where the burden is higher.

In some developing countries, more than 25 percent of patients admitted to hospitals acquire HAIs. The consequences of HAIs include long-term disability, preventable deaths, and increased antimicrobial resistance.

When the annual impact of HAIs is compared with the mortality statistics for other global threats—seasonal influenza (36,000 deaths in the United States every year), pandemic flu (18,000 deaths worldwide in 2009), SARS (775 deaths worldwide during 2002–2003), and H5N1 avian flu (375 deaths worldwide since 2003)—it becomes clear that HAIs are responsible for far more deaths on an annual basis than many of the better-known pandemic threats.

Fortunately, many HAIs can be prevented when public policy requires and incentivizes healthcare facilities to implement comprehensive infection prevention and control practices.

Beyond providing substantial healthcare cost savings and better patient outcomes, enhanced HAI prevention and detection strategies will help contain future regional pandemic threats by strengthening pandemic readiness through enhanced frontline infection control.

A major goal of the APEC HAI initiative is the establishment of a regional public–private capacity building network comprising stakeholders representing all 21 APEC economies. To achieve this goal, it will be necessary to strengthen local and regional collaboration for surveillance capabilities, as well as data collection and best-practice sharing.

The upcoming APEC host years (China in 2014 and the Philippines in 2015) will provide excellent opportunities for continued progress in these areas.


DividerWilliam R. Bishop Jr. is chair of the ACCJ Healthcare Committee and director of corporate affairs at Nippon Becton Dickinson Company, Ltd.