Hospitals look to improve infection-prevention measures

March 1, 2007

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 will impose new reporting and prevention measures on hospitals beginning next year. Pennsylvania and Missouri are among the states that require hospitals to publicly report their rates.

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.

COOPERATIVE EFFORTS

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.