The infection challenge: Proactive hospitals realize the value of prevention

By Kathy Warye

Within the past decade, healthcare-associated infections have become a critical issue for American hospitals. Consumer groups and the media have elevated these infections to something of a cause celebre—a fact that has created state and federal legislative pressure. Currently, 27 states require some type of public reporting of these infections, and pending federal legislation would also require public disclosure of infection rates. Congress recently mandated major changes to Medicare reimbursement effective this October. Starting then, the CMS will stop reimbursements for eight conditions considered “preventable” that develop after a patient is admitted to a hospital. In 2009, the CMS will add more to the list. Half of the conditions for which the CMS will no longer pay are infections.

Increased calls for transparency and accountability, along with threats of denied reimbursement, certainly raise the stakes for hospital leadership. But in addition,consider that, according to the Centers for Disease Control and Prevention,“more than 70% of the bacteria that cause hospital-associated infections are resistant to at least one of the drugs most commonly used to treat them.” With a limited arsenal of new drugs on the horizon, preventing infection must be the priority. It also is making more sense from a business perspective. Generally, only larger hospitals employ physician epidemiologists, but every hospital has infection prevention and control professionals. The dollars spent on them are much less than the cost of infections.

Preventing nosocomial infections only happens when top leaders target zero infections as the vision and heed the advice of infection prevention and control professionals. These specialists work to identify and isolate sources of infections to limit their spread. That includes collecting, analyzing and communicating data to advance performance improvement and safe practices. In the face of public pressure to reduce nosocomial infections, it’s time for leaders to understand the often overlooked talents that these professionals bring to saving lives and improving the bottom line.

Methicillin-resistant Staphylococcus aureus is now emblazoned on the popular consciousness as a result of reports that it kills more Americans than AIDS. In 2007, the Association for Professionals in Infection Control and Epidemiology, or APIC, conducted the first nationwide prevalence study, which showed that the rate of MRSA is eight times higher than previously estimated.

Forward-thinking hospitals are replacing finger-pointing with fresh insights and innovations led by their infection-control professionals. A bundle of elimination strategies, comprising evidence-based best practices, is highly effective at combating the spread of MRSA—but only when employed consistently. When everyone does it right the first time, 100% of the time, dramatic and measurable progress results.

In an informal APIC polling, we asked members to identify what’s changed over the year since the prevalence study. More than three-quarters (76%) of respondents said additional MRSA interventions were adopted. Yet more than half (54%) said that their institutions were not doing as much as is necessary to prevent the spread of MRSA. So while this progress marks an excellent start, there is more to be done to combat these infections.

Adhering to the fundamental principles of MRSA prevention will reduce other types of infection as well. Success means that leaders establish an organizational culture that strives to eliminate preventable infections and allocate resources to efforts that target institutionwide prevention, education, measurement and process improvement.

Other potent benefits accrue to the hospital committed to thinking differently about infection prevention and control, especially if leaders are willing to declare it as an organizational priority and support it with adequate resources. In such an environment, infection prevention ceases to be a stand-alone department; rather, it adds value to every aspect of patient care. Lessons learned from infection
prevention can improve other areas of patient safety, foster transparency and raise the organization’s standing in the community.

Kathy Warye is chief executive officer of the Association for Professionals in Infection Control and Epidemiology, Washington.
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Canada Hospital Launches Clean Hands Campaign

Banners such as "Clean Hands Save Lives" and "Stop and Sanitize" greet patients, employees, and visitors at Windsor Regional Hospital in Canada. The hospital has launched a new campaign in hopes of stopping the spread of infection, especially the country's recent strain of C.diff. The hospital's president and CEO recognized that, '"something as simple as hand washing, that we learn as young children, can save lives."' He also admitted that the primary transmitter of infections such as C.diff are contaminated hands. He's right. Experts estimate that less than 50% of healthcare professionals adequately wash their hands.
Along with their hand hygiene campaign, Windsor Hospital is also one of the only Ontario hospitals that publicly reports its infection rates.

Please visit the Windsor Star for more information: http://www.canada.com/windsorstar/story.html?id=6057ca88-47f7-4f83-b7df-5d48d552bf53

MRSA and Handwashing

Beating MRSA has become a focal point for heathcare professionals. Why? APIC, the Association for Professionals in Infection Control and Epidemiology, who is gathering in Denver this week for a national conference, noted that the occurrence of MRSA last year was about 8 times higher than estimated! But, infection experts wonder, how can MRSA be stopped when healthcare professionals don't follow simple guidelines, like handwashing?

It is estimated that less than half of healthcare professionals adequately wash their hands. What does it mean to adequately wash your hands? It means scrubbing for at least 20 seconds, or for enough time to sing the "Happy Birthday" song...twice. The understaffing of nurses and the urgent need for patient care has caused some healthcare professionals to admit that it takes too much time to perform correct hand hygiene. Other obstacles, such as the fire marshal saying that too many alcohol based gels are a fire hazard, also stand in the way.

But, like Rebecca Peters, an infection control staffer, said, '“It doesn’t matter if it’s God himself or the governor or whoever, you have to wash up."'

Please Read more at: http://www.msnbc.msn.com/id/25200398/

Or visit the APIC website at http://www.apic.org/

Focus on C-diff

Gut superbug causing more illnesses, deaths
By MIKE STOBBE, AP Medical Writer

ATLANTA - The number of people hospitalized with a dangerous intestinal superbug has been growing by more than 10,000 cases a year, according to a new study.

The germ, resistant to some antibiotics, has become a regular menace in hospitals and nursing homes. The study found it played a role in nearly 300,000 hospitalizations in 2005, more than double the number in 2000.

The infection, Clostridium difficile, is found in the colon and can cause diarrhea and a more serious intestinal condition known as colitis. It is spread by spores in feces. But the spores are difficult to kill with most conventional household cleaners or antibacterial soap.

C-diff, as it's known, has grown resistant to certain antibiotics that work against other colon bacteria. The result: When patients take those antibiotics, competing bacteria die off and C-diff explodes.

This virulent strain of C-diff was rarely seen before 2000.

"The nature of this infection is changing. It's more severe," said Dr. L. Clifford McDonald, a Centers for Disease Control and Prevention expert who was not part of the study.

There are other factors that play into the rise of C-diff cases as well, including a larger of number of patients who are older and sicker. "And there may be some overuse and inappropriate use of antibiotics," said Dr. Marya Zilberberg, a University of Massachusetts researcher and lead author of the study.

The Zilberberg study was based on a sample of more than 36 million annual discharges from non-governmental U.S. hospitals. That data was used to generate the study's national estimates.
The research is being published in the June issue of Emerging Infectious Diseases, a CDC publication.

Using other scientists' estimates, the study concluded that 2.3 percent of the cases in 2004 were fatal — about 5,500 deaths. That was nearly double the percentage of C-diff-related cases that ended in death in 2000.

Many of the people who died had other health problems. The study did not try to determine if Clostridium difficile was the main cause of death in each case, Zilberberg said.

But earlier research concluded the infection is the underlying cause of thousands of deaths annually, and the problem is getting worse.

C-diff has become an acute health concern in Canada, where it was blamed for 260 deaths at seven Ontario hospitals recently, and 2,000 deaths in Quebec since 2002.

The Association for Professionals in Infection Control and Epidemiology is currently working with U.S. hospitals to study prevalence of the infection and what infection control measures seem to work best.

"This is not a time for alarm, but more a time for educating health professionals to understand this particular pathogen," said Kathy Warye, chief executive of the Washington, D.C.-based association.


For more information, the CDC publication: http://www.cdc.gov/ncidod/EID/index.htm

High Five for a Healthy New Hampshire

“High Five for a Healthy New Hampshire” is a hand hygiene consciousness campaign that aims to increase hand hygiene and reduce hospital-associated infections. Every healthcare facility in New Hampshire has joined the campaign and pledges to abide by the “5 fingers” of the program. “High Five” strives to be 100% in compliance with the CDC’s Guideline for Hand Hygiene in Health Care Settings, and their website includes a video and a power point presentation about good hygiene, among additional hand hygiene links and resources. Tools to help track hand hygiene are also available along with posters and stickers.

For more information see the article in the Nashua Telegraph:
http://www.nashuatelegraph.com/apps/pbcs.dll/article?AID=/20080511/HEALTH/909155251/-1/health
or visit the “High Five” website directly: http://www.healthynh.com/fhc/initiatives/high5/index.php

Resurgent Honors Nurses during National Nurses Week

Resurgent encourages hand hygiene and infection control

GOLDEN, Colo. May 6, 2008 — Resurgent Health and Medical, a leader in automated handwashing and sanitizing technology, announced today the recognition of the 2.9 million Registered Nurses working in the United States. Resurgent has worked aggressively with hospital and medical facilities to promote and encourage hand hygiene and infection control.

"We're committed to assisting and helping the nurses that work so hard on a daily basis to care for all the patients throughout the United States. We are working with hospitals to encourage zero tolerance for lapses in hand hygiene with our CleanTech systems," says Jim Glenn, CEO of Resurgent Health and Medical. "Nurses wash their hands so many times during the day, and hospitals and facilities should provide better systems and measures to help make this necessary hygiene step easier and more pleasurable."

Resurgent Health and Medical delivers state of the art employee hygiene technologies to hospitals and healthcare facilities, restaurants, meat-processing plants, dentist offices, etc. that are serious about infection prevention and the elimination of dangerous pathogens in the workplace.

Resurgent’s systems replace the inconvenience and inconsistency of manual handwashing with a totally automated approach to infection prevention. It is the first fully-automated, touchless system available in healthcare for mechanical handwashing, rinsing and sanitizing. It performs a ten-second cycle using a non-alcohol disinfecting solution. By making handwashing quick and easy to perform, the system increases healthcare workers' compliance to a hand hygiene program. It further boosts compliance by ensuring a pleasant, uniform handwash using high-pressure water jets that perform a consistent wash-and-sanitize cycle every time the machine is used.

In addition, handwashing compliance can be measured automatically. A patent-pending radio-frequency identification (RFID) employee badge reading technology, combined with data-reporting software, provide hospitals with automated monitoring and reporting of handwashing events.

About Resurgent Health & Medical
Resurgent Health and Medical delivers state of the art hand hygiene technologies to hospitals and healthcare facilities that are serious about infection prevention and the elimination of dangerous pathogens in the healthcare industry. Our patented CleanTech® infection prevention technology brings science and precision to the process of removing dangerous microbes from the hands. For almost 20 years, CleanTech® brand systems have been used worldwide in agriculture, food processing, food service, cleanroom manufacturing and healthcare. CleanTech uses up to 75% less water than manual handwashing, discharges 75% less wastewater, and reduces waste in soap utilization. For more information, visit http://www.resurgenthealth.com

Anthem Blue Cross No Longer Reimbursing Major Preventable Events, Including HAIs

Anthem Blue Cross Announces Initiative Aimed at Preventing Serious Medical Errors; Company Committed to Protecting Members' Health and Finances by Not Reimbursing Major Preventable Adverse Events

WOODLAND HILLS, Calif., April 2, 2008 /PRNewswire/ -- Anthem Blue Cross announced today process changes for its hospital network to be implemented this year. The changes will include reimbursement modifications and are aimed at eliminating preventable adverse events as defined by the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum. They will help protect Anthem Blue Cross's eight million members from additional payments resulting from these errors."

Anthem's primary focus will be to ensure that physicians and hospitals are using appropriate processes, technologies and strategies to address 'never events' and, ultimately, to enhance the quality of care delivered to hospitalized patients," said Dr. Zeinab Dabbah, Chief Medical Officer of Anthem Blue Cross. "We will continue to work collaboratively with physicians and hospitals to analyze why and how these events occur, and to proactively find ways to improve patient safety and clinical care."

Anthem's first phase of the initiative includes 11 preventable adverse events and will be modified and expanded in the future. Anthem recently communicated to its network hospitals about its policy intended to ensure that no one will be charged if any of the following three events occur:

-- Surgery performed on the wrong body part; -- Surgery performed on the wrong patient; and -- Wrong surgery performed on a patient.

In addition, Anthem's changes will help ensure that only the appropriate payment is made and no additional charges are incurred if any of these events occur:

-- Object left in the body during surgery; -- Air embolism or blockage; -- Blood incompatibility; -- Catheter-associated urinary tract infection; -- Decubitus (pressure) ulcers; -- Vascular catheter-associated infection; -- Mediastinitis (an infection inside the chest) after coronary artery bypass graft (CABG) surgery; and -- Hospital-acquired injuries such as fractures, dislocations, intracranial injuries, crushing injuries and burns.

"We are listening to our members, business coalitions, and our key accounts who want to know their health plan is looking out for them," said Leslie Margolin, president of Anthem Blue Cross. "As a strong advocate for patient safety, Anthem firmly believes that putting processes in place that focus on preventing these events can have an immediate impact on health care safety and quality."