Good data, strong leadership and accountability can help control the rate of infection.
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| Lee Ann Runy |
Hospital-acquired infections (HAIs) are a significant public health threat with serious implications for hospitals. Nearly 2 million patients acquire an infection while in the hospital each year; about 90,000 of those patients die as a result.
Infections caused by multidrug-resistant pathogens lead to greater lengths of stay and an increase in morbidity and mortality. This costs the U.S. health system about $5 billion a year, the Institute of Medicine reports. As of Oct. 1, the Centers for Medicare & Medicaid Services no longer provide reimbursement to hospitals for costs related to certain HAIs. And the Joint Commission’s 2009 National Patient Safety Goals include a requirement that hospitals implement evidence-based practices to prevent HAIs due to multidrug-resistant organisms. The message is clear: Hospital executives must provide visible leadership to address barriers to infection control within their organizations.
Health Forum convened a panel of hospital executives and industry experts July 24 in San Diego to explore the challenges hospitals face in the treatment and prevention of HAIs. The discussion examined the cultural barriers that inhibit infection control, as well as the impact of resistant organisms on hospitals’ infection control efforts.
Hand Hygiene
Hand hygiene is a critical part of infection control, yet studies show that compliance generally remains below 50 percent. “Clinicians and others too often don’t appreciate the fact that they may be exposing a patient to infection,” said Robert Press, M.D., chief medical officer of NYU Langone Medical Center in New York. “It’s a cultural issue, but it’s an educational issue as well.”
Senior executives need to establish a culture of safety within the organization and assign accountability for lapses in care, the panelists said. “The issue of hand washing simplifies a larger condition,” said Rick Foster, M.D., senior vice president of quality and patient safety for the South Carolina Hospital Association in Columbia. “It comes back to leadership engagement and culture and creating a level of shared accountability.”
At Sharp HealthCare in San Diego, organizational goals include meeting infection rate benchmarks such as surgical-site infection rates. “Everyone’s compensation is tied to that,” said Nancy Pratt, R.N., Sharp’s senior vice president of clinical effectiveness. “There isn’t a leader at Sharp HealthCare who doesn’t know what we’re doing on infections.”
Real-Time Data
Engaging senior leaders will help build commitment among the medical staff. Physicians also need concise, pertinent data to inform them how their practices directly impact infections and antimicrobial resistance within the organization. “We have to provide physicians with credible data in a timely manner,” said Joseph Cacchione, M.D., executive vice president of Saint Vincent Health System in Erie, Pa. “We provide our physicians with data on a monthly basis and not just on infections. We give our surgeons information about the timing and choice of antibiotics.” That information, he said, has helped change physician behavior.
But many hospitals do not have access to that level of data. “Lack of information has been and continues to be a problem,” said Pratt. “The infection control arena is probably the most underserved area involving information technology in health care today.” The majority of states now require some form of reporting of infection rates. Yet the data collection process can be daunting. “Infection control practitioners are spending a great deal of their time tracking and reporting metrics,” said Press. As a result, he added, “They don’t have time to undertake some of the prevention measures they really want to do.”
Sense of Ownership
Hospitals need to adopt best practices to prevent infections and stem the growth of antimicrobial resistance. The key is to remember that it’s everyone’s problem. “We have to create a shared sense of ownership across the organization,” said Pratt. “I can throw all kinds of experts at the problem, but without a shared sense of ownership, we won’t achieve the results we need.”
Lee Ann Runy is senior editor of custom publications at Hospitals & Health Networks.
A full copy of the discussion, “Hospital-acquired Infections: Leadership Challenges,” is printed in the October 2008 issue of Hospitals & Health Networks and is available at www.hhnmag.com.
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