Specter of Job Cuts Looms Over CDC’s Infection-Tracking Efforts

The epidemiology community is hoping a federal program to thwart infections among patients and health-care staff will emerge intact amid job cuts and reorganization at the Centers for Disease Control and Prevention.

The concern about federal surveillance for health care-associated infections, or HAIs, comes as a drug-resistant fungus, Candida auris, is spreading in hospitals in the US and around the world.

The CDC, the premier microbiology laboratory, maintains the National Healthcare Safety Network, the nation’s leading HAI tracking system.

More than 38,000 hospitals, nursing homes, dialysis centers, and other health-care facilities report data through the network, which helps the CDC and its state and local partners identify and respond to HAI outbreaks and prevent recurrences.

“Nobody wants to go into a hospital with a problem and end up with an infection that they didn’t come in with,” said David Weber, president of the Society for Healthcare Epidemiology of America.

Yet C. auris—which can be deadly for patients with compromised immune systems—grew from 51 US cases in 2016 to 4,514 in 2023, the CDC reported. Containment requires “rapid identification” and “adequate resources” for “infection prevention programs and clinical microbiology laboratories,” according to research published last month in the American Journal of Infection Control.

But after Health and Humans Services Secretary Robert F. Kennedy Jr. announced plans to eliminate 2,400 CDC employees, Weber and others working to prevent infections fear the safety network’s staff and infrastructure could be on the CDC’s organizational chopping block—even though no funding cuts have been reported at this time.

“We fear that the whole thing is going to go. We think it’s going to disappear,” said Carol McLay, president of the Association for Professionals in Infection Control and Epidemiology.

Potential Impact of Downsizing

Downsizing the network’s operations, or easing its mandatory infection reporting requirements, could cause HAIs to spike and undermine public confidence in the health-care system amid ongoing concerns about Covid-19, bird flu and C. auris, which spreads readily among patients in medical facilities and attaches to hard surfaces.

“When a patient gets it, it is very hard to get rid of,” Arturo Casadevall, a professor of microbiology and immunology at the Johns Hopkins’ Bloomberg School of Public Health said of C. auris. “This stuff is pretty tenacious. It causes major medical problems.”

If downsized or eliminated, Casadevall said, it could take years to reconstitute the CDC’s fungi-tracking mycology unit, a small group of scientists, epidemiologists, and lab personnel who test and analyze C. auris samples and share their findings with physicians, researchers, and the public.

“There aren’t that many people who know how to do that. It is not something you can get rid of and re-assemble,” he said. “What I am concerned about is when teams are broken up, a lot of knowledge is lost. And that is not that easy to put back.”

The HHS did not respond to a request for comment about CDC job cuts or the status of the safety network.

“There is a lot of uncertainty, and I can tell you that none of us know what’s going on,” Casadevall said.

Warning System

Roughly one in 31 hospitalized patients becomes infected each day with an HAI, the HHS estimates. Some 680,000 HAIs each year add untold billions of dollars to health-care costs, the agency estimates.

The infections are often acquired during surgeries, or through medical devices, like catheters and ventilators. But many are caused by antibiotic-resistant pathogens. HAIs and other infections can lead to sepsis, which causes roughly 1.7 million illnesses and kills some 270,000 people each year, according to research.

Because some facilities are better than others at preventing infections, the mandatory infection reporting requirements of the NHSN provide a crucial warning system that helps save lives, McLay said.

Easing those NHSN requirements could allow HAIs to “potentially go unchecked,” in health-care facilities, McLay said. “That’s a huge fear. That impacts every single person.”

A recent analysis from the American Hospital Association found patient quality measures on mortality and health-care related infections were improving, “even while hospitals care for more patients with significant health care needs,” said a statement from Akin Demehin, the AHA’s vice president of quality and patient safety policy.

Along with HAI reporting, the network’s data includes vaccination rates for millions of patients and health-care workers, and helps medical facilities compare their infection data.

The CDC was expected to invest an additional $60 million a year in Covid-19 supplemental appropriations from FY 2022 through FY 2026 to modernize and expand the network, a CDC fact sheet said. But when “supplemental funds end, CDC will not be able to continue supporting this important work at the current level,” according to the fact sheet.

President Donald Trump hasn’t yet issued his FY 2026 budget proposal.