Infection Prevention
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THE PRIMARY COST to patients with hospital-acquired infections is a prolonged stay and additional therapeutic interventions.
But because of the high financial costs, there is increasing outside pressure to decrease infection rates.
Laws have been implemented in at least 15 states to force hospitals to improve their prevention efforts. In Massachusetts,
a new law calls for mandatory education of healthcare workers and penalizes facilities that don't comply with prevention measures.
In California, a bill signed into law in September will impose new reporting and prevention measures on hospitals beginning
next year. Pennsylvania and Missouri are among the states that require hospitals to publicly report their rates.
MHE Executive View
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About 2 million patients a year acquire an infection after admission, according to the Centers for Disease Control and Prevention
(CDC). The CDC estimates that patients contract 250,000 infections from catheters alone, and that between 12% and 25% of those
patients die as a result.
The financial costs of hospital-acquired infections are absorbed by health plans and their payers, members and providers.
The CDC's latest figures estimate that hospital-acquired infections add an additional $4.5 billion annually to the cost of
healthcare in the United States. A study conducted by the Pennsylvania Health Care Cost Containment Council showed that when looking at private sector insurance
reimbursements in the state, the average payment for a case with a hospital-acquired infection was $53,915, while the average
payment for a case without a hospital-acquired infection was $8,311.
"It is a difficult area to control," says Victor Caraballo, MD, senior medical director of quality management for Independence
Blue Cross in Philadelphia. "The causes are multi-variant and involve different areas of the hospital and different levels
of staffing. It's a major patient safety concern."
Each patient on a general floor alone can have upward of 20 different encounters with staff in one day. Patients with compromised
defenses and trauma victims on ventilators are most susceptible to infection, but any patient is at risk.
Numerous clinical studies, including one from Johns Hopkins University, show that relatively simple changes in behavior—better
hygiene by the hospital staff, for example—can have a profound impact. There appears to be evidence to reinforce the findings
of those studies.
Michigan hospitals that rigorously implemented infection-control procedures, such as doctors and nurses washing their hands
and cleaning patients' skin with an antibacterial agent before inserting intravenous lines, reduced catheter-related blood
stream infections in intensive care units patients from an average of 7.7 per 1,000 days of catheter usage to 1.4 per 1,000
days within 18 months, according to a report in the New England Journal of Medicine in December.
COOPERATIVE EFFORTS
Some hospitals are collaborating to meet the challenge. In Philadelphia, the Healthcare Improvement Foundation, the Delaware
Valley Healthcare Council and Independence Blue Cross have created the Partnership for Patient Care (PPC), a quality and patient
safety effort by area hospitals.
Those involved in the partnership discuss collaborative ways to encourage the rapid adoption of evidence-based medicine and
uniform procedures for preventing infections. Hospitals use a method called Failure Mode and Effects Analysis to analyze processes
and outcomes with the aim of finding new and improved ways to prevent infections.
"What we found is that cooperative efforts are very useful," says Charles Wagner, MD, chief medical officer of Holy Redeemer
Hospital and Medical Center in Philadelphia, one of the facilities involved in the PPC.
