Pessimism about conquering infections is the biggest obstacle, Pronovost says

Despite evidence that shows most catheter-related bloodstream infections (CRBSIs) can be prevented, they remain a persistent problem for many hospitals. Targeting a zero infection rate seems unrealistic to many.

"By far, the biggest barrier is people just don't believe they can do it," says Dr. Peter Pronovost, a patient safety leader who has been involved in the Michigan Keystone project that cut the incidence of CRBSIs by two-thirds, saving more than 1,500 lives and $200 million in 18 months. He spoke at a press conference sponsored by the Association for Professionals in Infection Control and Epidemiology (APIC).

Accepting high infection rates have become the norm, he notes, rather than the exception. An estimated 80,000 patients a year develop catheter-related bloodstream infections (CRBSIs) in the U.S., and some 30,000 die from them. The average cost of caring for a patient with these infections can exceed $30,000 and cost the U.S. healthcare system more than $2 billion a year.

Barriers to combating the infections are in the eyes of the beholder. ICU nurses say the culture is a problem. They can't question the doctors. Physicians who insert catheters in the ICU may say supplies aren't available. Infection preventionists complain that they're spending all their time on surveillance, monitoring, and not improving practices. Hospital CEOs may not even be aware of the infections.

Leaders may seem like an obstacle. Although half of infection preventionists surveyed strongly agree that their facility's administration understands the extent of the CRBSI problem, only 30 percent strongly feel their leaders are willing to spend the money needed to prevent those infections, according to a surveyed released Monday by APIC.

APIC CEO Kathy Warye notes that administrative leaders often see infections only as a cost center, when better infection prevention and control can help boost profitability.

To see the opportunity cost of needless infections and deaths, visit www.safercare.net. Then input two numbers, the yearly total number of central-line days and the CLABSI rate (number of infections per 1,000 central line days) for an ICU, hospital, or hospital system. The website generates the costs associated with the infections and potential impact of interventions in terms of deaths, dollars and ICU days.

The CEOs have to be engaged. The Michigan Health & Hospital Association Keystone Center gets CEOs and other leaders involved in fighting infections by having them fill out this checklist.

While Pronovost praises CMS' move to align payment with outcomes as "spot on" and "long overdue," he says that the 2008 rule that reduces reimbursements for 10 hospital-acquired conditions considered preventable (including CLABSIs) has shortcomings. The outcomes aren't necessarily measured accurately, he says, noting that administrative data--such as discharge data--gets outcomes right one in four times. "Doctors don't believe infection rates based on discharge data," he says.

Billing data may be accessible and inexpensive, he says, but "it's just not accurate." He blames it for containing too much chatter and prefers CDC definitions for outcomes. While there is no federal mandate to collect CLABSI data, Pronovost favors a national mandate.

To learn more:
- read the press release from APIC
- visit the safercare.net site to estimate the cost and potential savings associated with your CLABSIs

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