10 Strategies to Eliminate Healthcare-Associated Infections

Every year, more than 35 million people in the United States go to hospitals to get better.  Per the CDC, 1 out of every 31 of them experiences a healthcare-associated infection (HAI) while they were being treated for something else. These infections have emotional, medical, and financial effects. More importantly, they can be deadly and many are preventable.

Common types of HAIs are:

1. Catheter-associated urinary tract infections (CAUTI)
2. Central line-associated bloodstream infections (CLABSI)
3. Surgical site infections
4. Clostridium difficile (C.diff)
5. Methicillin-resistant Staphylococcus aureus (MRSA)

Impact on Hospitals

HAIs have a large, direct, financial impact on hospitals. For instance, the cost of care for CLABSI is estimated to be $45,000. HAIs are also related to longer patient length of stays, driving up cost of care.

Due to CMS initiatives, these costs are not reimbursed. Additionally, 25 percent of hospitals with the highest hospital-acquired condition (HAC) rate (which factors in many HAIs) face a one percent Medicare payment reduction across all their reimbursements under the HAC Reduction Program. In 2017, 751 hospitals had their Medicare payments reduced.

Although a one percent reduction in Medicare reimbursement may not sound like much, it could make a significant difference in a hospital’s ability to survive in today’s highly competitive market with shrinking margins. For example, if a hospital’s annual patient revenue is $1.5 billion and about 25 percent comes from CMS reimbursement, that’s $375 million. A 10 percent penalty is $37.5 million. These are dollars an organization needs for things like facility improvements, staff salaries and benefits and equipment.

Organizations must aggressively implement measures to improve performance and reduce HAI rates if they hope to avoid future penalties and reduce the cost of care.

Impact on Patients

HAIs affect approximately 1.7 million patients every year, causing 99,000 deaths.  Many of these deaths are preventable by taking the right steps.

Beyond the significant mortality implications of HAIs, there is evidence that patients experience an emotional toll as well.  Patients have indicated that they “feel blamed” for having an infection and that they feel “dirty”. Discharged patients often are left unfairly and unfoundedly worrying about the risk of transmission to their families and loved ones. It was determined that “all forms of HAI led to adverse consequences on patients’ social lives and relationships.”

Importance of Striving for Zero

HAI reduction is often seen as low hanging fruit due to their preventable nature. Studies show that evidence based intervention programs can result in up to 66 percent sustained reduction of certain HAIs, saving lives. It is also shown that targeted education and training of health care staff can reduce HAI rates through reinforcing the best practices of infection control, hand hygiene, and antibiotic stewardship.

Here are 10 strategies an organization can use to maximize performance on the prevention of complications:

1. Educate staff and physicians about:
   • HACs and prevention measures
   • Evidence-based guidelines
   • Assessing patient risk for HACs
   • Communication and teamwork
   • Patient education
2. Assess the organization’s HAC risks based on services provided, patient populations, and performance history
3. Implement HAC policies and procedures based on evidence-based guidelines
4. Continuously monitor performance on HACs through surveillance, rounding, event reporting, and other means
5. Foster a culture of safety and evaluate regularly. Staff should feel safe to speak up about and report patient safety events, including Close Calls, No Harm, Temporary Harm, and Sentinel Events without fear of punishment
6. Standardize processes, procedures, equipment and tasks. Systems should make it difficult to make mistakes and easy to do the right thing
7. Support strict adherence to hand hygiene and other infection control standards
8. Identify patients at highest risk for HACs and allocate resources and prevention strategies accordingly
9. Use checklists and other tools to ensure complete and accurate actions are implemented
10. Educate patients and family members about ways they can help minimize the risk of HACs

Final Thoughts

We should strive to eliminate deaths related to preventable infections or conditions acquired while patients are being treated for something else. We have seen that education, training, and increased vigilance related to medical devices and antibiotics can take us there. We have started down the path, with an 8% reduction between 2014 and 2016, but there is still significant improvement to be made.