IRVING, Texas -- An estimated 90,000 people die in the U.S. each year because of hospital-acquired infections. In addition, two million hospital-acquired infection cases add between $7 billion and $30 billion to the nation’s healthcare bill each year.
The good news is that clinical studies have shown that these healthcare-associated infections are largely preventable, and VHA Inc., the national healthcare alliance, is launching a national initiative to reduce and eliminate hospital-acquired infections (HAIs) over the next three years. VHA’s HAI initiative will focus on the following clinical initiatives:
-- Preventing central line infections
-- Preventing surgical site infections
-- Preventing ventilator-associated pneumonia
-- Improving hand hygiene, isolation and barrier precautions
-- Implementing active surveillance methods
-- Making behavior, cultural and organizational changes
“VHA has proven it can engage its members to drive clinical improvement,” said Betty Wilson, RN, director of clinical performance at VHA. “If our members focus on hospital-acquired infections, they will make changes that will foster safer, more effective and more efficient health care.”
“Hospital-acquired infections signal that less than optimum care is being provided, and we’ve got to raise the bar,” said Ken Smithson, MD, vice president of research at VHA. “It’s the right thing to do for patients, and it has a significantly positive impact on a hospital’s bottom line.”
One of this national initiative’s elements involves engaging VHA members in regional collaboratives to help hospitals measure and track their performance over time. One collaborative that already is underway focuses on eliminating methicillin-resistant Staphyloccus aureus (MRSA) bacteria. MRSA infections are becoming more commonplace in hospitals and cause as many as 50,000 deaths annually. Through this program, VHA will help hospitals develop new and innovative ways to collaborate with peer organizations, share best practices, measure and benchmark performance, and learn from top MRSA experts.
Through the use of proven, evidence-based interventions, effective coaching, measurement tools and best practice sharing, hospitals can improve their clinical and economic performance relative to hospital-acquired infections. VHA is sponsoring several clinical improvement initiatives to help its members approach HAIs in different arenas and will develop new programs over the next three years. Several existing VHA programs already have generated strong results:
Transformation of the Intensive Care Unit Program— Intensive care units (ICUs) have the highest incidence of HAIs. Participants in VHA’s Transformation of the Intensive Care Unit (TICU) program dramatically have decreased their incidence of HAIs and changed the way they deliver care. The program provides participants with the tools and methodologies, training and guidance, and measurement necessary to transform their ICU care.
By focusing on a set of simple techniques proven to improve patient outcomes and using the tools provided by TICU, Hartford Hospital in Hartford, Conn. changed its culture and cut its nosocomial infection rates in its medical intensive care unit (MICU) in half — which puts the hospital in the 15th percentile nationally. Other improvements experienced between July 2002 and March 2004 included:
-- Decreased average length of stay by 8 percent
-- Decreased adjusted costs by 3 percent
-- Increased admissions by 9.5 percent because of available beds
-- Increased MICU revenue by 13 percent
Transformation of the Operating Room Program — Surgical site infections cost hospitals thousands of dollars each year in unreimbursed care, and more patients than ever are taking legal action for medical errors occurring in the operating room (OR). Participants of VHA’s Transformation of the Operating Room (TOR) program have learned that, through implementation and evaluation of evidence-based care, and changes in culture, they can improve the care they deliver in their OR. TOR participant, Billings Clinic in Billings, Mont., decreased total knee arthroplasty infections by 86 percent decrease and coronary artery bypass graft infections by 71 percent, saving the organization an estimated $224,000.
Surgical Site Infection (SSI) Prevention —Through VHA, NewportHospital in Newport, R.I. learned that proper antibiotic usage, timing and procedure help reduce SSI rates. The hospital implemented several practice changes and has maintained low SSI rates, one percent below the Centers for Disease Control and Prevention’s National Nosocomial Infection Surveillance System (NNIS) benchmark. Community Health Network in Indianapolis, Ind. has been working on SSIs since 2001 and has participated in several VHA clinical programs to learn infection control best practices. In its first year working with VHA, Community Health reduced its SSI rates by 50 percent, and in ’01-’02 it estimates it saved $324,000 by avoiding four cases. Since 2003, the hospital has kept its rates at two percent below the NNIS benchmark.
Catheter-related Blood Stream Infections (BSI) — Since October 2004, Covenant HealthCare System in Saginaw, Mich. has maintained a zero BSI rate in its critical care units. CommunityMedicalCenter in Scranton, Pa. has maintained a low to zero BSI rate since January 2005. The hospital has seen zero infection cases for 273 consecutive days.
Best Practices Symposium: Eliminating Hospital-acquired Infections —VHA recently hosted a national conference in Baltimore, Md. about preventing and eliminating HAIs. The conference was attended by more than 125 infection control experts and other clinical leaders. VHA formed a peer-to-peer networking group following the conference to keep the attendees engaged on this topic.
VHA will sponsor numerous programs at the state, regional and national level over the next three years to emphasize the importance of this movement to eliminate hospital-acquired infections. VHA also will continue to collaborate with health industry partners, such as the Joint Commission on Accreditation of Healthcare Organizations and Centers for Medicaid and Medicare Services, to:
-- Work on new techniques to identify quickly the type and source of HAIs: MRSA, vancomycin-resistant Enterococci (VRE), Clostridium difficile (C. diff.), Legionella, etc.
-- Improve pneumococcal pneumonia / influenza immunization access
-- Disseminate education on the proven practices that help reduce the likelihood of HAIs: optimal device management, employee vaccination, glycemic control, wound care
-- Broaden HAI educational opportunities via Web-based initiatives and satellite broadcasts
-- Work with members to help them better manage antibiotic usage, which contributes to the development of resistant bacteria
-- Work on data collection, reporting and improving measurement, benchmark methods
Source: VHA Inc.