Infection control practitioners (ICPs) are becoming increasingly active in house-wide product selection. ICT asked the experts to share some pointers on creating an overall win-win situation in this playing field.
Our expert panel:
Rita McCormick, RN, infection control practitioner at the University of Wisconsin Hospital and Clinics located in Madison, Wisc.
Robert W. Yokl, vice president of operations with Skippack, Penn.- based Strategic Value Analysis in Healthcare
ICT: What are the two most overlooked aspects of selecting a product?
McCormick: 1. Clinical effectiveness studies are extremely important. In vitro studies provide limited data regarding how effective the product will be in the clinical situation. The strength of evidence should not be overlooked. Often one finds anecdotal before/after reports which are often not well controlled. Randomized controlled clinical trials provide much stronger evidence of effectiveness.
2. Cost effectiveness of a product is also important.
Yokl: 1. Have a system in place. This is probably the most important thing. You have all these department heads and managers that do buy everyday, but there is nothing systematic; there is no way to do it, but just say, ‘Go save money.’ You’ll do it the best you can. When you are dealing with millions of dollars, you really should have a system in place. When it gets to a certain point in a study and it is a clinical product, we should go to the IC professionals and ask for their expert opinion — and they should in turn have criteria to come back to say ‘Well, it needs to meet these requirements.
2. Set some goals before even performing a study. So many times I see organizations go out and they don’t set goals. For example: reduce the rate of urinary tract infections. That is the goal when you are looking at the whole product line for that (use). That way you will be able to pinpoint where you need to focus on a product.
ICT: Can you offer some tips on what “red flags” to watch for concerning a product, company or sales person that should deter the evaluation committee from purchasing the product?
McCormick: Lack of efficacy information. Shiny brochures with no substance are generally rejected by well-informed ICPs.
Yokl: Every company is going to have its biased case studies; they’re only going to show you their best. You really need to validate that for yourself. Sales people are going to say things that need to be evaluated by the committee.
ICT: Can you share some pointers on what to investigate about a product that extends from the product itself (i.e. service packages, repairs, warrantees, etc.)?
McCormick: I agree with the aforementioned examples. Packaging and ease of use should also be considered. Packaging often dictates shelf space necessary both in central supply as well as inpatient and outpatient storage areas. Storage space is frequently limited.
Yokl: Much of this should be built into your product evaluation or value analysis process. Once again, it goes back to having a system in place. The thing to key in on is that you need to meet the specifications exactly for your customers. That is what this is all really about.
We overshoot or we undershot, it costs us money or quality and we want to make sure we find out exactly what our customers want and need. For example, a value analysis study by a hospital was done so well (a capital equipment purchase of new endoscopes) that they actually saved enough in the process to buy a few more scopes. They did such a great job in the overall analysis, but they missed a crucial element — the items were to be used primarily by one doctor, but he did not first use the product. When he did, he didn’t like the way it felt when he used it. They ended up wasting all that time and money in their analysis. Sometimes it is the simplest things like trying it out.
When you do a product evaluation, starting from the department head ordering it all the way out to it leaving your organization, you really have to look at it throughout its life cycle — every little detail. As a rule of thumb, anything below $20,000 can be handled through regular channels. Have a validation point in place.
ICT: What type of rapport should persons on the product evaluation committee create with the company sales representatives?
McCormick: The rapport should be professional in nature. Recently there have been expectations set that speakers, authors, etc., disclose associations with industry. While this is a step in the right direction each person needs to carefully examine potential conflicts of interest and consider if he/she should participate in the selection of a specific product if a conflict of interest may exist.
Yokl: Try to use them as a resource. I had a 10-hospital system that had to do an IV set study. The IV companies will help you out with that; they have practitioners that come from the clinical side. If the vendors have (experts), use them. Of course you have to validate, but use them. Why not? — Just like committees should use their ICPs as their IC experts.
ICT: What type of training would be essential before participating on a product evaluation team?
McCormick: Review of the facility’s ethics policy, ability to do an adequate literature search of relevant published articles.
Yokl: No. 1, I would say IC should really spend a day in purchasing. Truly learn how purchasing works. Sit in on a sales meeting. I definitely recommend at least 20 hours worth of training. Not a lot of companies offer that training, but it is available. Definitely seek out that training. They want to understand the whole dynamic of how it works, and if there are existing teams, sit in on those teams. It is valuable information. You have everything to gain and nothing to lose.
ICT: What, in your opinion, can an ICP offer by his or her presence on the product evaluation committee?
McCormick: Raise questions regarding efficacy of product to reduce the patient’s or employee’s risk of infection.
Yokl: When IC does things, believe me, they have documentation on everything. They have to. They keep databases of all sorts of things. They have the unique position of handling things house-wide too. They have that perspective. That’s what they bring to the table: they deal with all of the clinical areas and sometimes not clinical areas. Sometimes something as simple as hand soap in the public bathrooms is important, and they see the importance of those aspects.
I think IC people know that they can ask the dumb question: ‘Is this causing infection issues here?’ Sometimes just asking a straightforward question is the best way to go.
I think it is well worth it. I don’t think they should just be a monitor.
I think they should be an active member. I think that they would carry a lot of weight on these committees and that they are valuable.
ICT: What aspects would you prefer ICPs become more assertive or active about?
McCormick: On occasion major decisions regarding products are made without infection prevention being considered. An example may include the decision to purchase IV pumps without considering the type of needleless connector or valve incorporated in the administration set to be used with the pump. Not being informed or involved in the review process doesn’t allow ICPs to weigh in with an opinion.
Yokl: We have a team approach. We like to see everybody have a project. It’s a great learning approach. There can be anywhere from 4,000 to 25,000 different products. Can you imagine having to cover that? You have to have a process in place.
ICT: How much influence should an ICP hold on this type of committee?
McCormick: It may depend on the credibility of the individual ICP.
Well read, well informed ICPs who can think analytically will probably hold a fair amount of sway. Typically the ICP is in a position to make a recommendation not a decision. For large decisions one should seek input and support from the infection control committee. Most decisions come down to risk/benefit ratios.
Yokl: Definitely a committee member, and as they become comfortable with the committee, I think they need to develop their own checklist or criteria (tests that an item needs to pass). They (ICPs) are very open to making changes, but it has to work in their minds.
ICT: How valuable is an ICP’s opinion in product selection?
McCormick: It can be extremely important but ICPs must also be somewhat flexible. Sometimes one has to choose what sword one wants to die on.
Yokl: Very valuable. I mean just about every product evaluation should be stopping in that department. They’re your experts. I’m encouraged that infection control is getting more involved with value analysis. They are taking an interest in product evaluation and they very well should. Sometimes we forget about those things and with infection rates, it is really important that IC is used as a resource and an expert.
It is very encouraging to have ICP active on these committees. It is very valuable. It is just better that they are involved.
ICPs Can Play Key Role in Product Evaluation and Selection
The Association for Professionals in Infection Control and Epidemiology (APIC) recommends that new products and devices be evaluated to ensure that healthcare personnel can be trained in its use and to circumvent any issues concomitant with a new, unfamiliar technology. APIC suggests that products to be considered must be safe, effective and conducive to high-quality patient care; that they be employed by a committee with clearly defined responsibility and authority; that they be evaluated based on objective criteria; that a trial be conducted before selecting a product; and that an annual review should be done of the policies and procedures associated with product evaluation and selection.
In its Recommended Practices for Product Selection in Perioperative Practice Settings, the Association of periOperative Registered Nurses (AORN) advocates collaboration and a multidisciplinary approach to the selection process as a part of these practices, specifying all departments that use, purchase and select products be represented. AORN provides an exhaustive list of potential committee members, which includes surgical services, nursing services, administration, pharmacy, materials management and purchasing, anesthesia risk management and others. A dedicated infection control representative is also recommended.
Such products should also conform to the facility’s own product evaluation committee (PEC), and APIC suggests that the PEC be comprised of individuals in the following roles:
Materials management Nursing Administration Medical staff Training Infection control Clinical engineering Suppliers of healthcare products are affected directly by the PEC. First, they must ensure that their product is presented to the committee, but direct contact with the PEC is not always allowed. There are several ways to introduce and influence the healthcare facility to view a new product fairly; these include:
Individual presentations detailing the value and efficacy of the product to individual and group decision-makers within the healthcare facility A formal presentation to the standardization committee if direct contact with the committee is allowed Education presentations to various organizations, at which decision-makers are present Direct-mail pieces sent to decision-makers explaining product features, benefits and value
1. Dix K. ICPs, Nurse Managers Play Critical Role in Product Selection. Infection Control Today. November 2002.
2. Ellis K. Medical Product Selection is a Group Effort. Infection Control Today. July 2004.