Eradicating MRSA, Making a Business Case for Infection Prevention Top the To-Do List for ICPs

It has been a very busy year for the infection prevention and control community; its members have continued to watch for signs of an impending avian influenza pandemic; they have continued to lobby and prepare for mandatory reporting of healthcare-acquired infections (HAIs) in their respective states; and they have continued to wage war against an increasing number of infectious agents whose virulence and persistence have caught the attention of the mainstream media as well as healthcare consumers.

As infection control practitioners (ICPs) continue to serve as key facilitators in facilities compliance with mandatory reporting requirements, they are realizing the critical need to ensure the viability of their infection control programs and departments in order to perform their jobs and meet their facilities high expectations. ICPs are therefore starting to grasp the concept of making a business case for infection prevention and control, and assuming the role of partners in profitability with hospital financial leaders.

The fact is, most hospitals dont understand the costliness of infections, says Richard Shannon, MD, chair of the Department of Medicine at Allegheny General Hospital in Pittsburgh, Pa. The costs of these preventable infections in both human and economic terms are staggering.

At Allegheny General, Shannon proved that HAIs in general, and central line infections (CLABs) and ventilator-associated pneumonias (VAP) in particular, are not inevitable consequences of complex healthcare but are indicative of unreliable processes. He demonstrated that these infections and their consequences can be reduced through work standardization and commitment to safety. As a result, infection prevention became the hospitals fourth most profitable product line. Allegheny General Hospital saved $2.2 million by reducing CLABs and VAPs by 80 percent to 90 percent. Most importantly, 47 lives were saved.

Professionals in infection prevention must learn the business of healthcare and preventing infection and adverse outcomes for those who entrust us with their lives and the lives of loved ones is our core business, says Denise Murphy, RN, BSN, MPH, CIC, vice president of safety and quality at Barnes-Jewish Hospital at the Washington University Medical Center in St. Louis. Good patient experiences are good business, and we know how to deliver that. Murphy, whose pioneering work shed light on the economics of infection prevention, participated in an initiative at Barnes-Jewish Hospital that made the case for the reinvestment in infection prevention. Evidence-based methods were used to reduce the occurrence of VAP in five intensive care units and show that HAIs result in substantial costs to patients and the healthcare systems.

A growing body of evidence proves that reduction of healthcare-associated infections saves lives and money, notes Association for Professionals in Infection Control and Epidemiology (APIC) president Kathleen Meehan Arias, MS, CIC. It is our goal to build the economic case for infection prevention and communicate it broadly to all who can make a difference. As part of this effort, APIC is in the process of creating a toolkit for its members that will help them make a clear and comprehensive business case at their facilities and use this knowledge to secure increased resources to further fight HAIs. The organization also is cultivating relationships with other organizations that share APICs commitment to prove infection prevention saves lives and money.

We will provide hospital financial leaders with a clear, concise and compelling message that infection prevention is good for business, said APIC chief executive officer Kathy L. Warye. Most importantly, it saves lives and reduces human suffering and, as an added bonus it helps to create a healthy bottom line.

APIC also emphasizes the need for ICPs to develop new partnerships within their facilities and to identify leaders who will champion the activity. The infection prevention and control professional must be at the epicenter of the institution, Shannon adds. Partnerships and influence need to extend throughout the health care organization. Murphy adds, In order to gain the attention of key executives, we must concisely articulate what is needed to do the job well and the impact of doing the job poorly.

There is strong indication that these efforts are paying off. Research conducted by VHA Inc., a national healthcare alliance, reveals that close to 60 percent of ICPs time is spent on surveillance, communication, and management of infection control programs, and preventing infection transmission. Another substantial portion of their time (13 percent) is focused on education and training.

VHA worked closely with hospitals in 13 states between 2004 and 2005 to learn what hospitals are doing to reduce HAI rates and then provided assistance in improving infection control efforts. They looked at the duties of infection control staff, physician involvement, the products used to support infection prevention efforts, and clinical practice changes that hospitals were making to improve patient care and prevent HAIs.

Study findings support what we expected, that hospitals are adopting evidence-based practices to prevent HAIs and, over time, have allocated more resources and attention to infection control departments, says Marly Christenson, RN, MSN, senior director of clinical and performance improvement for VHAs mountain states office and lead author of the study. Hospitals are focusing on patient safety and making important changes to strengthen infection prevention efforts.

The study also reported that hospitals varied in their care processes and use of products designed to prevent infections. Hospitals converted to products recommended in Centers for Disease Control and Prevention (CDC) guidelines during the study period, such as use of chlorhexidine products (12.5 percent) to keep skin germ free. Additionally, half of the hospitals surveyed increased surveillance frequency of specific infection control markers, engaged nursing personnel in infection control activities, and reviewed and/or implemented evidence-based practice protocols.

Observation of basic handwashing practices revealed that nurses (86 percent) and respiratory therapists (84 percent) were more likely to follow CDC guidelines for hand hygiene after direct patient contact than physicians (60 percent). Hospital team coaching, individual consulting and targeted educational sessions through the course of the study helped to improve adherence to these basic care processes. For example, hand hygiene practices improved by more than 52 percent and practices to prevent ventilator-associated pneumonia by more than 10 percent.

Another issue on the minds of ICPs these days is the control, prevention, and eradication of methicillin-resistant Staphylococcus aureus (MRSA). While APIC notes that the countrys healthcare system is losing its fight against antibiotic-resistant infections, Warye comments that her organization is at war against MRSA and has vowed to take the lead in a national effort to arm infection prevention professionals with the comprehensive tools necessary to wipe out this spreading infection. She adds that APIC wants to see a significant and sustained reduction in MRSA until each institutions rates are as low as they can go. The MRSA epidemic through this country is symptomatic of something wrong with the healthcare system overall, Warye says. I think its fair to say the system is broken.

Adding that infection prevention and control professionals cannot do this alone, Warye says that in order for change to occur, healthcare professionals, both clinical and non-clinical, must commit to a culture of patient safety and vow to make the elimination of MRSA a top priority among each physician, nurse, and healthcare worker within their institution.

APIC plans to launch its fight against MRSA almost immediately through a variety of fronts, starting with a first-of-its-kind nationwide MRSA Prevalence Study that, when compiled, will give the healthcare industry a clearer picture of the scope of the problem. While the overall numbers of MRSA-afflicted patients are not yet known, they are believed to be on the rise, Warye says. The infection does not discriminate in whom it strikes but it is making worldwide news, particularly when noted officials or athletes are stricken with MRSA. Its wonderful that so many organizations have raised awareness of MRSA and its spread, but awareness alone will not solve the problem. It will take a total commitment on the part of the entire healthcare community working with infection prevention and control experts to eradicate this increasingly prevalent threat to our health and well being.

APIC is conducting this 2006 MRSA Prevalence Study this month to gather nationwide data on MRSA infections/colonizations in inpatients in U.S. healthcare facilities. The challenges we face from what some call the superbug warrant a comprehensive plan of attack, says Arias. The survey will provide a valuable baseline on this issue. The information we collect will help us empower infection prevention and control professionals with the tools they need to fight MRSA in healthcare facilities throughout the United States and the world.

APIC will use the information garnered from the survey to introduce and sustain an ongoing public awareness campaign on eradicating MRSA; provide ongoing education on strategies to control MRSA; and initiate a call to action to CEOs and chief medical officers at healthcare facilities to gain their commitment.

Preventing the spread of MRSA will take a sustained effort on the part of the entire healthcare community, Warye says. We urge healthcare leaders to join with us to fight this increasingly virulent and costly health threat.