Infection Prevention Meets Bottom Line

December 27, 2007
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About one in 10 patients in U.S. hospitals gets sick from infections they pick up during hospital stays, according to the federal Centers for Disease Control. That’s 1.7 million cases per year, at a cost of $5 billion.

And 99,000 die annually from infections that develop as a consequence of health care, the CDC says. Medicare has named infections associated with three common procedures for which it will no longer reimburse hospitals, starting later this year.

Last year’s appearance of Legionnaires’ disease in the plumbing system at Saint Mary’s Health Care’s Lacks Cancer Center in Grand Rapids was a departure from the long-identified list of infections common in health care settings such as hospitals and nursing homes.

The most prevalent of health care-associated infections, at 32 percent, are urinary tract infections, usually as a result of catheter use, according to the CDC. That’s followed by surgical site infections, at 22 percent; pneumonia, 15 percent; and bloodstream infections, 14 percent. The infection control staffs at Grand Rapids-area hospitals add methicillin-resistant staphylococcus aureus — also known as MRSA — as one of their important concerns.

Dr. David Baumgartner, vice president of medical affairs and an infectious disease specialist, said Saint Mary’s recently has placed a special emphasis on post-surgical infections.

“We’re focused on that through ensuring that we’re using the guidelines for prevention,” he said. “That includes things like using electric clippers rather than razors, giving prophylactic antibiotics prior to surgery. There’s a particular focus on infections related to total knee and total joint replacement, after neurological surgery, spine surgery and colon surgery.

“Those are high volume areas for us, areas where we want to make sure we have the best possible outcomes.”

At the new Metro Health Hospital in Wyoming, Dr. Steven Triesenberg said that the 208 private rooms are expected to help contain hospital-acquired infections.

“We had a major campaign in the past year to improve our hand-washing,” Triesenberg said. “That sounds like a minor thing, but actually it’s probably one of most important things a hospital can do.”

Spectrum Health nurse and manager of infection control Cathy Ostrowski said measures such as hand-washing, cleaning and education of staff, patients and visitors are never-ending but important tasks. She said the hospitals are in daily contact with the county and state health departments.

“It’s that constant surveillance, not just looking at those microbiology reports every day, but looking at the environment and looking at our patient population and making sure we appropriately isolate patients, and making sure we're complying with hand hygiene,” she said.

“We work closely with Environmental Services, and obviously they're my favorite people because their role of disinfecting surfaces is so important.”

Standardization of infection control practices is a proven and measurable approach, Ostrowski added. The Michigan Health and Hospital Association’s Keystone Center for Patient Quality & Safety has enlisted 108 hospitals in its health care-acquired infection program.

“Our role is to translate evidence-based, best practices from the research bench to the bedside,” Keystone Executive Director Sam Watson said. “That’s being done through a number of initiatives in intensive care units, organ donations, stroke care, and most recently, hospital-based infections.”

Kimberly Sepulvado-Haught, project coordinator for Keystone’s hospital-acquired infections program, said the focus is on four facets: a comprehensive, unit-based safety program; adequate hand hygiene; urinary tract infection prevention; and bloodstream infection prevention. The tools range from surveys about safety to observation of hand-washing compliance to reviewing ICU patients to find those who don’t really need urinary catheters.

A year go, the New England Journal of Medicine published a Johns Hopkins study of Keystone data that looked at infection-prevention practices in 103 Michigan ICUs for sterile placement of central venous catheters.

“We can literally prevent bloodstream infections,” Watson said. “We’ve seen a median rate of zero for several months. That means that they are still occurring, but the incident rate has been reduced about 90 percent.”

Some of the measures used: staff training; hand-washing; avoiding catheter insertion near the groin; use of gowns, gloves and masks during placement; disinfecting the patient’s skin; limiting supply cards to a single use; and, as with urinary catheters, removal as soon as possible.

“That attention to detail is what drove that infection rate down,” Watson added.

By October, prevention of health-care acquired infections will come down to dollars and cents. Medicare announced last summer it will not longer pay for treating eight preventable hospital errors, including infections associated with urinary catheters, blood lines and coronary bypass surgery.

Also on the no-pay list: injuries for a hospital fall; reactions from wrong blood-type infusions; air embolism; bed sores that develop in the hospital; and medical objects left inside people during surgery.

Some insurance companies are expected to follow suit.

“The business community and those who are paying for health care have a significant stake in this, as well,” Watson added. “The efforts of preventing harm, preventing infection, preventing errors from occurring also has a positive effect in terms of saving dollars, which we clearly need to do in the health care system.”     HQX

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