Thursday, June 5, 2008

Guest Blog: The War Being Waged Against Hospital Acquired Infections by Thomas Cherry

Warning: You May Find The Statistics You Are about to Read Alarming

One in every 20 hospital patients contracts an infection unrelated to their primary condition during a hospital stay, adding up to approximately two million people each year.

According to estimates from the U.S. Centers for Disease Control (CDC), hospital acquired infections (HAIs) claim the lives of approximately 90,000 patients annually, a number greater than breast cancer and auto accident deaths combined.

While these statistics are certainly alarming, the good news is that hospitals across the globe are stepping up their infection prevention initiatives and the war against HAIs is heating up. Dirty hands, inadequately cleaned equipment and lax procedures are all contributing to the dilemma and have become the subject of the infection prevention initiatives. In the U.S., a variety of organizations, including the CDC and the Institute for Healthcare Improvement (IHI), have put forth guidelines and campaigns designed to assist hospitals and medical centers in reducing infection rates. To date, these initiatives have made a significant impact on national infection rates.

Compelled by this growing awareness of HAIs, healthcare facilities are now paying more attention to one of the most fundamental HAI prevention measures – the practice of proper hand hygiene.

Over time the emphasis placed on hand hygiene has emerged and progressed. Today the debate over cleansing hands with soap versus antiseptic agents has pursued, but the underlying stress on hand hygiene cannot be denied. Not only does the implementation and execution of accepted hand hygiene practices reduce the potential risks of transmitting infections from caregivers to patients, it also protects health care workers from obtaining infections caused by microorganisms acquired by the patient.

As infections are most often transmitted through the contaminated hands of health care workers, hospitals must ensure that their staff is fully educated on the importance of hand hygiene compliance and that barriers to achieving hand hygiene are adequately eliminated. Basic hand washing involves cleansing hands with soap and water. Antiseptic cleaning agents used in conjunction with diligent hand washing can also assist in combating bacteria. New guidelines developed by the CDC and infection control organizations recommend that health care workers use an alcohol-based antiseptic to routinely clean their hands. When water is not available waterless antiseptic agents can be applied to hands. However, if hands are visibly soiled soap, which could contain an antiseptic agent, and water are recommended.

In healthcare settings, patient needs are paramount and as a result, hand washing initiatives may fall behind in priority of care in an emergency situation. As one would also expect, caregivers are often pressed for time and in these busy healthcare facilities pressure situations tend to decrease compliance. This is especially true in facilities that are overcrowded or understaffed, as this environment could keep health care workers from taking the proper hand washing precautions.

Additionally, there are health care workers who forget the guidelines or who are not even aware of these recommendations. In this case, educational materials posted around facilities can inform, remind and inspire compliance through emphasizing the value of and support for adherence. Promotional and “watchdog” programs and incentives can also serve to establish expectations and encourage observation of best practices.

In addition to proper hand hygiene, other methods can be used to help improve infection rates. One method is the use of gloves during patient care. However it is important to note that gloves should never serve as a substitute for proper hand hygiene practices. Another essential practice is sterilizing medical devices before and after use, including stethoscopes, blood-pressure cuffs and chest tubes. Additionally, hospitals are adopting the use of devices, such as central venous catheters, that have been impregnated with antibiotics. Of course, antibiotic-impregnated medical devices should be used in conjunction with best placement practices to achieve the most effective outcome.

As illustrated above, there are several challenges to adherence to hand hygiene techniques and guidelines by health care workers but with the proper procedures in place they can be overcome. With approximately two million infections each year, HAIs result in approximately $4.5 billion in excess costs. These cost considerations coupled with increased national awareness require hospitals to seriously examine procedures and precautions necessary to combat HAIs and ultimately ensure the best quality of care for their patients. Infection prevention is a responsibility for all members of the hospital and with a solid commitment and adherence to infection control best practices hospitals worldwide will undoubtedly experience a significant reduction in HAI rates.

Thomas Cherry, Clinical Product Manager of the Critical Care division of Cook Inc.


Scott Hodson said...

Beginning October 1, Medicare will no longer pay hospitals for care provided to resolve hospital acquired conditions. This has the potential to significantly reduce medicare expenditures and hosptial revenues.

For example, vascular catheter associated infection represents a major area of impact. A significant number of patients rely on vascular access devices, like PICC lines, to deliver needed medication. The line has to be placed and maintained in a specific manner, or it has a potential to cause a catheter-related bloodstream infection (CRBSI.) CRBSI, along with ventilator-associated pneumonia (which CMS is considering adding to the “selected conditions” list for FY2009), are the two most costly infections to treat.
Analysis in one Midwestern hospital identified that the average cost to treat a CRBSI was $91,000, whereas the average reimbursement was about $67,000 – an operational loss of $24,000. As of Oct. 1, 2008, reimbursement will be zero. The CDC estimates 250,000 central line-associated infections occur in the United States annually, with an attributable mortality rate of 12 to 25 percent.

This change in reimbursement methodology will create a significant incentive for hospitals to improve quality management.

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My employer is compensated through funding to provide analytical research, technology solutions, and Web-based public and private health care performance reports by the State of New York, the State of Illinois, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Commonwealth Fund and Bridges to Excellence. I am not being compensated by any of these organisations to create articles for or make edits to this Web site or any other medium; and all posts authored by me are as an individual and do not represent my employer or the agencies I work for.