InfectionControlSource

By Barbara A. Goldrick, RN, MPH, PhD, CIC, Clinical Editor

The vast majority of patients who have access to healthcare today are restored to health. However, some will suffer unintended consequences of care, such as healthcare-associated infections (HAIs). HAIs can occur in all healthcare settings, including hospitals, surgical centers, ambulatory outpatient clinics, and in long-term care facilities. (1, 2) HAIs are associated with a variety of causes, including the use of medical devices, complications following a surgical procedure, and transmission between patients and healthcare providers. (2) In addition to the substantial morbidity caused by HAIs, the financial burden attributable to these infections is estimated to be between $28 to $33 billion in additional healthcare costs each year. (3)

Prevention of HAIs has become a national priority, with initiatives led by healthcare organizations, professional associations, government agencies, and accreditation organizations. Evidence-based practices for the prevention of HAIs have been established by organizations committed to improving the safety and quality of patient care. (4)

Four device- and procedure-associated HAIs have been targeted for prevention:

• Central line–associated bloodstream infections
• Ventilator-associated pneumonia
• Catheter-associated urinary tract infections
• Surgical site infections.

In addition, two organism-specific HAIs, methicillin-resistant Staphylococcus aureus (MRSA) infections and Clostridium difficile infections, have been targeted due to the increasing incidence and morbidity associated with these microorganisms. (2, 4, 5)

In January 2010, the 2009 revised Joint Commission National Patient Safety Goal 7: “Reduce the risk of health care–associated infections” became effective. Healthcare organizations can meet the Joint Commission goal by compliance with established hand hygiene guidelines and by implementing evidence-based practices to prevent central line-associated bloodstream infections, surgical site infections, and infections due to multidrug-resistant microorganisms such as MRSA and C. difficile. (5)

Additionally, as mandated by Section 5001(c) of the 2005 Deficit Reduction Act, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the CDC and other healthcare groups identified a number of hospital-acquired conditions that were “high volume, high cost, or both and could reasonably have been prevented through the application of evidence-based guidelines.” (6)

Consequently, the CMS Inpatient Prospective Payment System Final Rule for Fiscal Year 2009 states that hospitals will not receive additional payment for cases in which one of the following HAIs was not present on admission: catheter-associated urinary tract infections, vascular catheter-associated infections, and surgical site infections following coronary artery bypass graft (CABG), bariatric surgery, and selected orthopedic procedures. (6)

The goal of the 2010 2nd Edition of the Kestrel InfectionControlSource is to explore current evidence-based practices that prevent HAIs and provide products to assist healthcare providers and administrators in their efforts to improve patient safety and reduce healthcare costs.

References:

1. Singh N, Brennan P, Bell M. Primum Non Nocere. Infect Control Hosp Epidemiol 2008; 29: S1-S2.
2. Department of Health and Human Services. Action Plan to Prevent Healthcare-Associated Infections. [On-line] at: http://www.hhs.gov/ophs/initiatives/hai/draft-hai-plan-01062009.pdf.
3. Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009. Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, February 2009.
4. Yokoe D, et al. A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. Infect Control Hosp Epidemiol 2008; 29:S12-S21.
5. The Joint Commission. 2010 National Patient Safety Goals. [On-line] at:
   http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/.
6. Centers for Medicare and Medicaid Services. Hospital-Acquired Conditions. [On-line] at:
   http://www.cms.hhs.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp .