Hospitals Look to Improve Infection Prevention Measures

The primary cost to patients with hospital-acquired infections is a prolonged stay and additional therapeutic interventions. But because of the high financial costs, there is increasing outside pressure to decrease infection rates.

Laws have been implemented in at least 15 states to force hospitals to improve their prevention efforts. In Massachusetts, a new law calls for mandatory education of healthcare workers and penalizes facilities that don't comply with prevention measures. In California, a bill signed into law in September imposed new reporting and prevention measures on hospitals beginning in 2007. Pennsylvania and Missouri are among the states that require hospitals to publicly report their rates.

About 2 million patients a year acquire an infection after admission, according to the Centers for Disease Control and Prevention (CDC). The CDC estimates that patients contract 250,000 infections from catheters alone, and that between 12% and 25% of those patients die as a result.

The financial costs of hospital-acquired infections are absorbed by health plans and their payers, members and providers.

A study conducted by the Pennsylvania Health Care Cost Containment Council showed that when looking at private sector insurance reimbursements in the state, the average payment for a case with a hospital-acquired infection was $53,915, while the average payment for a case without a hospital-acquired infection was $8,311.

"It is a difficult area to control," says Victor Caraballo, MD, senior medical director of quality management for Independence Blue Cross in Philadelphia. "The causes are multi-variant and involve different areas of the hospital and different levels of staffing. It's a major patient safety concern."

Each patient on a general floor alone can have upward of 20 different encounters with staff in one day. Patients with compromised defenses and trauma victims on ventilators are most susceptible to infection, but any patient is at risk.

Numerous clinical studies, including one from Johns Hopkins University, show that relatively simple changes in behavior—better hygiene by the hospital staff, for example—can have a profound impact. There appears to be evidence to reinforce the findings of those studies.

Michigan hospitals that rigorously implemented infection-control procedures, such as doctors and nurses washing their hands and cleaning patients' skin with an antibacterial agent before inserting intravenous lines, reduced catheter-related blood stream infections in intensive care units patients from an average of 7.7 per 1,000 days of catheter usage to 1.4 per 1,000 days within 18 months, according to a report in the New England Journal of Medicine in December.

Some hospitals are collaborating to meet the challenge. In Philadelphia, the Healthcare Improvement Foundation, the Delaware Valley Healthcare Council and Independence Blue Cross have created the Partnership for Patient Care (PPC), a quality and patient safety effort by area hospitals.

Those involved in the partnership discuss collaborative ways to encourage the rapid adoption of evidence-based medicine and uniform procedures for preventing infections. Hospitals use a method called Failure Mode and Effects Analysis to analyze processes and outcomes with the aim of finding new and improved ways to prevent infections.

"What we found is that cooperative efforts are very useful," says Charles Wagner, MD, chief medical officer of Holy Redeemer Hospital and Medical Center in Philadelphia, one of the facilities involved in the PPC.

Overall, hospitals involved in the PPC saw a 27% improvement in controlling blood sugar levels in surgical patients, strengthening the ability of a patient's immune system to fight infections; a 21% improvement in the use of antibiotics before surgeries to prevent infections; and a 9% improvement in adopting new safety measures to prevent bloodstream infections from intravenous central lines.

Developing measures for fighting infections must involve the frontline clinicians who have the most contact with patients, says Alexis Elward, MD, medical director of infection control for St. Louis Children's Hospital. One group at Children's Hospital—including nurses, physicians, infection control practitioners, and physical and respiratory therapists—has worked to improve hand hygiene by implementing CDC guidelines that recommend that hospital personnel wash their hands after each contact with a patient. The result is that hand hygiene at Children's Hospital has improved from 60% in mid-2006 to the current level of 94%.

Another multi-disciplinary group, which includes personnel from pharmacy and anesthesia, as well as surgeons, has worked to reduce the number of surgical site infections in cardiothoracic surgery patients.

"We know that getting antibiotics in patients within one hour before an incision is made, and using clippers instead of shaving hair, can decrease the quantity of germs on the skin," Dr. Elward says. "A small group of people got together and created a system where those things are done automatically."

Mar 1, 2007
By: Ken Krizner
Managed Healthcare Executive