At most health systems, infectious disease specialists play a leadership role in infection control and prevention, promote hand hygiene, advocate for staffwide vaccinations, oversee equipment sterilization and conduct infection surveillance. All these measures are important in reducing health care-associated infections and the spread of infectious diseases. But hospital administrators who think the value of infectious disease expertise ends there are missing out on a significant opportunity; they also risk losing their institution's money and reputation.
HAIs annually cause nearly 100,000 deaths and cost the health care system nearly $6.5 billion, according to the Centers for Disease Control and Prevention. While standard IC&P programs can help to reduce the incidence of HAIs, many health systems are not maximizing the full potential of their IC&P teams. Led, ideally, by infectious disease physicians who have the requisite training and expertise, IC&P teams can provide guidance in a wide variety of tasks — from consulting on equipment purchases to preparing emergency departments for outbreaks — to avoid or reduce devastating and costly infection-related problems.
Health system leaders are well aware that the Centers for Medicare & Medicaid Services is focused on reducing HAIs and that it now holds them to several HAI-related performance measures. Reimbursement is tied to HAI rates via the value-based purchasing system. Those who fall into the lowest quartile, based on HAI rates, are penalized. The best way to avoid that quartile isn't always clear: It requires more than surveillance and a few standard interventions.
Infectious disease physicians can assess which interventions are working — and which are consuming valuable resources without much impact. Their expertise enables them to identify where the hospital is vulnerable, prioritize improvement practices and implement those practices.
Hospitals can be penalized if they have too many central line-associated blood stream infections and Clostridium difficile infections. Knowing this, vendors are pushing myriad commercial products and procedures alleged to address these problems, from new dressings for CLABSI to ultraviolet light for C. difficile. Efficacy varies, and whether they would be beneficial in your health system depends on a number of factors. Infectious disease physicians can evaluate the data to determine which products will help your facility, and then design an effective implementation. Without input from a specialist, you risk purchasing products that waste funds.
Preparing for New Construction
When there's new construction, it's a smart tactic to involve infectious disease physicians long before the ribbon-cutting ceremony. In fact, these physicians should be included at every step, from blueprints to the finishing touches. They can prevent many problems from arising because of construction: They can assess if the planned method of air handling is appropriate and whether the materials and equipment are disinfectable, for example, and they can ensure that construction dust is contained so as not to harm vulnerable patients.
An infectious disease physician can assess relevant questions. If procedures are going to be performed in the new building, are there plans for dedicated equipment disinfection and enough sinks to ensure proper hand hygiene? What is the plan for safe waste disposal? Are there clean as well as dirty sinks, and is there enough space between them? Is there room for a biohazard trash can? These types of oversights are surprisingly common, and rectifying them after the fact can be difficult and costly.
Planning for Outbreaks
No one envies Texas Health Presbyterian Dallas Hospital, which had to contend with the first case of Ebola identified in the United States. But next time, it could be your hospital facing an outbreak, whether Ebola, Middle East Respiratory Syndrome, H1N1 influenza, severe acute respiratory syndrome, measles or some as-yet-unknown infection. Your facility must have a plan to manage such an outbreak, and that plan needs to be developed by a multidisciplinary team led by an infectious disease physician.
Such physicians help to plan protective mechanisms that work for your specific facility. These mechanisms may include contact precautions, patient screening, isolation measures and other responses to protect employees, patients and the public. As the Ebola experience demonstrated, many employees felt unprepared and frightened to care for a possibly infected patient. Research shows that employees who are trained in using IC&P equipment are less fearful and more confident in their ability to safely care for these patients. Infectious disease physicians can enact proven protective mechanisms and train employees so they feel protected while providing needed care.
On a related note, health care workers can be exposed to biohazardous material in providing routine patient care. Infectious disease physicians have the best expertise to address this not uncommon problem. Blood-borne exposures put workers at risk for contracting infectious diseases such as hepatitis and HIV. Infectious disease specialists are experts in providing the best management, medications and methods of prophylaxis.
Dealing with Disasters
Many facilities will have to contend with a local emergency (whether a tornado, flood or simply burst pipes) that results in possible infection-related consequences, so it makes good sense to have an infectious disease physician involved in disaster planning.
Consider burst pipes. Response needs to be immediate, and there needs to be a quick resolution to a wide variety of problems — prioritizing patients to be routed to an unaffected location, closing units to be disinfected, and ensuring that wet walls are dried effectively or replaced to prevent mold, which could put vulnerable patients at risk. If you lose water, are your sterilizers going to work? Will you be able to appropriately manage plumbing issues as the leak is being addressed? Infectious disease experts can provide guidance.
Hospital executives might consider the following steps to better use their IC&P resources:
- Contact your infectious disease specialist to discuss broader IC&P efforts. For more information about what these physicians do and how they can help your facility reduce the spread of infectious diseases, visit the Infectious Diseases Society of America website.
- Familiarize yourself with CDC resources on HAIs, especially carbapenem-resistant Enterobacteriaceae: There was a recent outbreak related to endoscopes at several health care facilities in Los Angeles. Infectious disease specialists are keenly aware of this and other drug-resistant infections and will play a critical role in responding to an outbreak and guiding best practices for disinfection of equipment.
- Become an IC&P champion yourself. It may sound simple, but leadership support and attention increases adherence to hand-hygiene protocols. Also, the CDC recommends certain vaccines for all health care workers for their protection as well as for the patients they treat. Hospital leaders should use infectious disease specialists to actively support and communicate the importance of vaccinations for staff members.
Infection disease physicians can have a positive influence throughout a health care system, yet their full potential remains untapped at many facilities. Forward-thinking leaders recognize the value of employing IC&P-dedicated physicians, often more than one, to decrease infections and increase safety. Infectious disease physicians help facilities to achieve safety; improve quality, care and outcomes; and avoid penalties in a cost-effective way.
Susan Bleasdale, M.D., is the medical director of infection prevention and control at the University of Illinois Hospital & Health Sciences System in Chicago.