The medical world has declared zero tolerance for healthcare-associated infections (HAIs), but it is a massive problem to address.
Seven out of every 100 hospitalized patients at any time and about 30% of patients in intensive care units will acquire at least one HAI, according to the World Health Organization.
HAIs such as Clostridium difficile (C. diff) and catheter-associated urinary tract infections (CAUTIs) take a heavy toll on patient outcomes and length of hospital stay. They are also expensive. The most common infection is CAUTI, accounting for more than 30% of HAIs, costing health systems about $500 million annually in the direct cost of treating patients.
Making matters worse, Medicare does not reimburse for certain HAIs, and a portion of reimbursements are withheld for the quartile of hospitals with the most HAIs. When Medicare penalties and lost revenues are included, the cost likely exceeds $1 billion annually.
Here are five specific areas where health systems can and must improve:
- Streamline workflows. Hospitals are reducing infection rates by using EHR systems to streamline workflows by making the right thing to do the easiest thing for clinicians to do. The idea is to remove unnecessary variation in the way care is delivered to ensure clinicians follow the best clinical practices. For example, it was once routine to place catheters in many hospitalized patients, but now catheters should only be used when the patients meet specific clinical criteria. Once inserted, EHR systems can be leveraged to remind clinical staff that a patient has a catheter and suggest they remove it or document why it is still indicated. Up to 69% of CAUTI cases can be prevented by following these and other evidence-based strategies.
- Stop overtesting. Hospital staff too often overtest for infections when there are not strong clinical reasons to expect an infection. For example, hospitals overtest for C. diff, the most common infectious cause of healthcare-associated diarrhea and a significant factor leading to morbidity, mortality and increased length of stay among hospitalized patients. This inappropriate C. diff testing leads to false positives and overdiagnosis. Using EHR systems to ensure care processes are aligned with current testing guidelines and workflow best practices can produce even bigger improvements. One hospital following this approach had a 50% reduction in C. diff infections.
- Focus on best practices. Getting CAUTI rates to zero means clinicians should set strict rules for testing and focus on the correct insertion, maintenance and removal of catheters. A study published in Infection Control & Hospital Epidemiology found that when ICUs at the Cleveland Clinic improved their catheter protocols that CAUTIs decreased from three per 1,000 catheter days to 1.9. Similar improvements can be made by ensuring clinicians focus on best practices throughout the care-delivery continuum.
- Minimize patient risk of infection. Whether it’s overuse of catheters or antibiotics, more rigorous hospital workflows can minimize infection risk. That was among the topics discussed in June at the Association for Professionals in Infection Control and Epidemiology (APIC) conference, where more than 4,500 infection prevention professionals gathered to discuss strategies to lower infection rates. The conference revealed that many hospitals and health systems still have multidisciplinary teams performing retroactive chart reviews of HAI cases to look for things that could have been done differently to mitigate the risk of infection. However, such retroactive assessments can never find the type of consistent process improvements that can be identified by a well-organized EHR, where you can look at and sort large data sets to find patterns. Rather than reviewing past cases, EHRs can even be set up to proactively make recommendations for clinicians.
- Improve infection controls. Once an infection is identified in a timely fashion, hospitals need consistent procedures to stop it from spreading. Those should include isolating the patient, clinicians wearing special gowns and gloves, special hand-washing procedures and, crucially, communicating those standards to staff.
It’s not uncommon in American hospitals for nurses to attempt to manage catheter hours by physically walking around wards, seeking out patients with catheters to assess whether proper care was performed and which catheters can be removed.
In an age when we use technology for everything from better navigation to movie recommendations, hospitals should use modern information technology available to them to push their HAI rates to zero as quickly as possible.
Brita Hansen, M.D., is chief medical officer of LogicStream Health. Prior to joining LogicStream, Dr. Hansen served as chief health information officer at Hennepin County Medical Center. She is also an assistant professor of medicine at the University of Minnesota School of Medicine.