Hospitals Become More Transparent About Infections

By Jennifer Larson, contributor

February 22, 2012 - Patients can now log onto Hospital Compare, the website operated by the Centers for Medicare & Medicaid Services (CMS), and find out how their local hospitals are doing at preventing certain hospital-acquired infections, or HAIs.

CMS recently updated the Hospital Compare website to include data provided from hospitals about their central line-associated bloodstream infections (CLABSIs). Hospitals with intensive care units began submitting data last January to the CDC’s National Healthcare Safety Network; in order to get full reimbursement in 2013, they will have to report CLABSI data for adult, pediatric and neonatal ICU patients.

With more data available to the public, hospitals may face more public scrutiny.

Hospital Acquired Infections
Alfred Connors, M.D., CMO of MedicalHealth, said, "What you want to do is make sure the preventable infections don't occur."

That’s fine with hospital leaders like Alfred Connors, M.D., chief medical officer of MetroHealth Medical Center in Cleveland, Ohio. He said he’s proud of the various efforts his hospital has undertaken to reduce nosocomial infections, including a hand hygiene campaign and an antibiotic stewardship program.

“With scrutiny like this, everybody will start doing a little better,” Connors said. 

“It’s a lot of work (reporting the data), but we feel that it’s a step in the right direction for building that culture of safety,” said Mary Holmes, infection prevention specialist for Roper St. Francis Healthcare in Charleston, S.C. “I think patients need to know what kind of hospital they’re stepping into.”

But others caution that it’s possible some members of the public may not fully understand the nuances of the data and its significance, and it will become increasingly important that there is consistency across all the data that is reported so that people can make accurate comparisons.

Hospital Acquired Infections
Dawn Garcia, BSN, divisional director of medical staff/quality with the Hospital Sisters Health System, suggests that hospitals closely study best practices for guidance on reducing their HAI rates.

“We want to share information that is accurate and relevant,” said Dawn Garcia, divisional director of medical staff/quality for the Western Wisconsin Division of Hospital Sisters Health System.

Rabih Darouiche, M.D., program director for the Multidisciplinary Alliance Against Device-Related Infections, noted that of course everyone should work diligently to eliminate hospital-acquired infections.

“There should be no tolerance whatsoever for doing things that should not be done,” he said. “But zero tolerance is sometimes misinterpreted in the sense that it may mean zero rate of infection.”

That’s setting the bar extremely high--perhaps impossibly so for some organizations, he said.

“I think it’s a good thing to project and to work for, but in reality it is extremely difficult to reach the zero rate of infection,” Darouiche continued. “In all hospitals, the fact of the matter is that infection control measures may, in and by themselves, not be able to reduce the rate of catheter-related bloodstream infections to below what the scientific organizations and regulatory agencies have put as a threshold.”

But it’s still worth aiming for. And Darouiche said he thinks the best way to approach that lofty goal is with a combination of strict infection control measure implementation and technology that has been proven to be effective.

And progress has definitely been made. For example, there has been a significant amount of improvement made in recent years to address infections like CLABSI, which is one of the most costly and deadly HAIs. Last March, the CDC reported a 58 percent reduction in CLABSIs in the United States from 2001 to 2009--approximately 25,000 fewer CLABSIs occurred in ICUs during that time period. According to the CDC, that translated into 6,000 lives saved and $414 million saved.

To achieve those reductions, many hospitals have employed prevention and reduction strategies like the Institute for Healthcare Improvement’s Central Line Bundle, which the IHI reports has led to some ICUs experiencing an entire year or more with no CLABSIs to report. The key components of the IHI Central Line Bundle are hand hygiene, maximal barrier precautions upon insertion, chlorhexidine skin antisepsis, optimal catheter site selection and daily review of line necessity and prompt removal of unnecessary lines.

Holmes noted that infection prevention efforts must be multidisciplinary if they are to succeed. “You’ve got to have every player involved in the reduction effort,” she said.

Will the increased availability of data further drive down infection rates in the future? Some say that it will because it will put some pressure on hospitals to work harder to improve.

Hospital Acquired Infections
Hudson Garrett, Ph.D., MSN, director, clinical affairs for PDI Healthcare, chairs the Association for Vascular Access Building a Better Bundle Committee, leading the fight against catheter related bloodstream infections.

“It really is going to not only put an impetus behind healthcare organizations to be more transparent but to also engage patients,” said Hudson Garrett, Ph.D., MSN, director of clinical affairs for PDI Healthcare.

And there is quite a bit of potential in the patient education arena. A growing number of organizations are putting more emphasis on patient education about hospital-acquired infections--how patients and their families can also play a role in reducing them.

For most organizations, the focus is on improving hand hygiene, since that’s an area where patients and families can truly have an impact.

At Garrett’s facility, patients now have access to a resealable container of hand-sanitizing wipes at the bedside--because it was determined that a wall-mounted sanitizer unit wasn’t accessible enough to bedridden patients to encourage better hand hygiene. At Garcia’s facility, all the patient rooms have cards mounted on the doors to explain the hand hygiene program--so visitors will know exactly what’s expected of them. And Holmes’ facility is preparing to launch an expanded hand hygiene campaign that will strive to incorporate patients and their families in the effort to reduce the spread of infection.

Connors said that a comprehensive and well-monitored hand hygiene program that was started in late 2010 has reduced the HAI rate in his facility. Specifically, the catheter-related bloodstream infection rate in the ICUs declined from 5 infections per month in the six months prior to the program to 2.1 per month for the 12-month period afterward.