The 'Zero' Mentality: Is it Good for Infection Control?

"Getting to zero," the emerging drive to eliminate infections acquired in hospitals, is provoking much discussion in the healthcare community, ranging from concern that the approach is overly simplistic and potentially dangerous to praise that it is a motivating and worthy goal. Healthcare experts will discuss this issue at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA) in Orlando, April 5-8.

"Like it or not, the concept of 'getting to zero' is here," says Patrick J. Brennan, MD, president of SHEA and chief medical officer for the University of Pennsylvania Health System in Philadelphia. "As infection control specialists, our job is to recognize the policy implications as well as the unintended consequences."

Michael Edmond, MD, hospital epidemiologist for the VirginiaCommonwealthUniversityMedicalCenter in Richmond, asks "Getting to Zero: Is it Safe?" and examines the genesis of the concept as well as the forces that are driving it. He discusses concerns that "zero tolerance" regulations could lead to unintended consequences and is setting people up not to deliver.

For example, some healthcare experts worry that putting an imbalanced amount of weight on the elimination of one pathogen in the hospital in response to legislation may contribute to conditions where another pathogen could flourish. Edmond proposes that all hospitals should be putting reasonable measures in place to prevent infection.

Arguing in favor of adopting the term "zero" as aggressive target to motivate people and institutions to move in the right direction, Victoria Fraser, MD, co-director of the Infectious Diseases Division of Washington University School of Medicine in St. Louis, addresses using the term "zero," even though it is not yet known what fraction of infections is preventable, nor is it known how much mortality rates can be reduced.

Also speaking at the session is Chesley Richards, MD, MPH, deputy director of the Division of Healthcare Quality Promotion of the Centers for Disease Control and Prevention (CDC). He explores the emerging financial, regulatory and legislative approaches being taken to promote "getting to zero." He comments on several bills before Congress that would require national reporting of hospital infection rates. Currently, 20 states have passed such laws. He also discusses Medicare's reduction of payments to hospitals in instances where patients acquire an infection in the hospital.

Source: Society for Healthcare Epidemiology of America (SHEA)

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