Every year about 2 million patients develop serious infections as a result of hospitalization for an unrelated condition in the United States — about 1 out of every 136 hospitalized patients.1 Not only do these healthcare-associated infections (HAIs) exact an enormous toll in personal terms, but the financial cost also is staggering: our country spends $4.5 to $5.7 billion annually on the treatment of HAIs.1 According to estimates, preventing a case of HAI saves on average more than $10,000 and reduces the patient’s risk of death from almost 7 percent to 1.6 percent.2
In the past, HAIs often were viewed as an inevitable consequence of hospitalization.3 Healthcare organizations considered prevention programs successful if they resulted in a relatively modest reduction in the incidence of HAIs. More recently, organizations including the Association for Professionals in Infection Control and Epidemiology (APIC) have proposed a goal of zero HAIs for prevention programs. Eliminating these preventable infections is the right thing to do for our patients and for our hospitals. Patients would avoid unnecessary complications, longer hospital stays, additional therapy, and possibly, premature death. Hospitals would free up valuable inpatient beds by avoiding longer hospitalizations due to HAIs.4
Healthcare facilities now have another important financial incentive for eliminating HAIs: loss of reimbursement. As of October 2008, the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse healthcare facilities for costs related to certain HAIs that could have reasonably been prevented through the use of evidence-based guidelines.5 Officials at CMS have indicated that they will be adding additional preventable conditions to the list in the future. For this reason, healthcare organizations should implement initiatives aimed at eliminating all HAIs rather than targeting the specific HAIs identified by CMS. Even without the incentive imposed by the new regulations, a hospital’s bottom line is better served by eliminating HAIs. These infections frequently lead to a net economic negative for healthcare organizations, because the costs of care associated with HAIs outstrip the reimbursement for additional therapy and hospital days.3-4
Recent changes in federal regulations on reimbursement and surveillance, widespread media coverage, and an increasing recognition of our obligation to improve patient safety have heightened attention on the need to use infection control interventions such as bundling techniques to eliminate HAIs. In addition, these changes have highlighted the need to use surveillance to track progress and measure the success of interventions to eliminate HAIs. Various types of surveillance methods have been tested. Active surveillance for specific pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), has been shown to reduce the incidence of hospital-acquired bacteremia in some populations.6 Screening at-risk patients upon admission for a specific organism such as MRSA can prevent transmission to others and result in fewer new infections and reduced net costs.7 Targeted surveillance and chart review has been shown to be more accurate than use of administrative data in case-finding for HAIs.8 Use of clinically based computerized information has been shown to be accurate, effective, and less time-consuming. A recent study found that a computerized surveillance system was as effective in identifying cases of surgical site infection (SSI) as manual methods and required less staff time (90 hours vs. 223 hours).9
Regardless of the methods used, implementing effective surveillance programs is not an easy task in an era of cost-containment. Many organizations report that their HAI prevention efforts are hampered by lack of resources. In a survey completed in October 2007, almost half of the more than 800 hospital clinicians involved in infection control cited inadequate resources as the most important infection prevention issue for their organization.2
Survey respondents identified timely and efficient tracking of HAIs across the entire hospital population as the most important HAI-related challenge to their organizations. What’s more, infection control practitioners (ICP) are responsible for a variety of tasks in addition to surveillance of HAIs: communication with other healthcare professionals and patients, education and training, conducting investigations, and controlling transmission. Completing time-consuming surveillance tasks may be difficult if regulatory or financial changes result in additional responsibilities for ICPs.
Given the heightened urgency for eliminating HAIs, ICPs may be called upon to take on additional responsibilities, such as state-mandated active surveillance duties and additional tracking and reporting tasks. Reporting requirements vary by state — from selected infections such as catheter-related bloodstream infections (CLABSI) or SSIs, to all HAIs, as is the case in Pennsylvania.
As healthcare professionals, we are at an important juncture in healthcare. We have an opportunity to improve patient care and help our organizations avoid costly reimbursement losses by eliminating HAIs. ICPs stand at a unique position within their institutions. Because of the interdepartmental scope of their work, their familiarity with performance improvement principles, and their involvement in performance improvement initiatives, ICPs are well-situated to assess the current readiness of their organizations to address HAIs. How will your organization deal with the upcoming CMS reimbursement requirements? How will the requirements affect your workload and work flow? Will you need additional technical skills, resources, or knowledge to effectively meet the challenges ahead?
Healthcare professionals have a responsibility to make choices that will improve patient care. The time has come for all of us to work for the elimination of HAIs — it is simply the right thing to do. ICPs are uniquely qualified to assess the resource needs of staff responsible for HAI-related prevention- related activities and to speak up if resources are insufficient for the uphill road ahead.
Dan Peterson, MD, MPH, is medical advisor for Premier Inc., and Salah S. Qutaishat, PhD, CIC, FSHEA, is epidemiologist/director of infection prevention and control for Premier Inc. Healthcare Informatics.
1. World Health Organization. Global Patient Safety Challenge. 2005. Available at: http://www.who.int/patientsafety/events/05/GPSC_Launch_ENGLISH_FINAL.pdf. Accessed October 24, 2007.
2. Premier Inc. Premier Healthcare Associated Infection Survey. October 2007. Available at: http:// www.premierinc.com/quality-safety/tools-services/safety/news/. Accessed October 24, 2007. Also see: Premier Inc. Premier SafetySurveillor. October 2007. Available at: http://www.premierinc.com/quality-safety/tools-services/performance-suite/infectioncontrol.jsp. Accessed October 24, 2007.
3. Association for Professionals in Infection Control and Epidemiology. Dispelling the myths: the true cost of healthcare-associated infections [white paper] February 2007. Available at: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Reports/hai_whitepaper.pdf. Accessed October 18, 2007.
4. Graves N. Economics and preventing hospital-acquired infection. Emerg Infect Dis.2004;10(4):561-6.