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Technology improves HAI prevention
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Since Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals was first published in 2008, there has been a major effort nationwide to address this quintessential marker of health care quality. These relatively concise guidelines offered practical standards for prioritizing and implementing prevention efforts for health care-associated infections such as central line-associated bloodstream infections, catheter-associated urinary tract infections and surgical site infections.
In 2011, the CMS began requiring hospitals to report specific types of HAI data to the National Healthcare Safety Network (NHSN). The focus on HAI prevention and forcing hospitals to track their numbers is having a positive effect. Reports show significant reductions in the number of HAIs from the 15% of patients estimated to develop infections in 2002.
Although data alone are valuable, the NHSN database also allowed the CMS to prepare for the next stage, which is to eliminate reimbursement for certain HAIs. The financial incentive to reduce HAIs will undoubtedly put infection preventionists in the spotlight and, hopefully, decrease the number of HAIs further.
Ashley Wheeler
For infection preventionists to effectively address these issues, they will need detailed data on what is happening in their own institutions, as well as an effective strategy for implementing change. The recently published 2014 update to the compendium states that the keys to successful HAI prevention efforts involve an integrated approach that requires elements such as an understanding of human behavior, fostering engagement and ownership of the improvement process, and education.
The drive to collect HAI data is necessary, but it has largely pushed infection preventionists into the role of data analysts with enormous amounts of time focused on compiling and reviewing numerous reports. The task of evaluating lab results and isolation candidates alone is extremely arduous and time-intensive on Monday mornings to catch up after the weekend, and then approximately 4 hours per day the remainder of the week in a 350-bed hospital. This has largely pushed the other elements of HAI prevention into the background.
One hospital’s experience
Our hospital has found meaningful improvement by implementing advanced technology. We adopted a seamless, real-time automated monitoring system (VigiLanz) that works with our standard EHR system. The surveillance software is based on a sophisticated set of rule engines that we customized for our institution to provide automatic, exception-based alerts in real time. Rather than sorting through stacks of lab reports, the software analyzes everything in a patient’s record and hones in on potential infections, drug-bug mismatches, conditions of concern, reportable infections, multidrug-resistant organisms and HAIs. Besides saving an enormous amount of time, the infection control monitor ensures that we catch all of the positive results.
Advanced infection control monitor systems also have features such as cluster tracking, which is helpful in tracking an infection to its origin. A specific infection or HAI can be evaluated according to all patients involved, when they were admitted, discharged, and any overlap in areas of the hospital and care providers. The software then generates graphs and charts demonstrating these connections, which have been easily understood by all involved stakeholders in our hospital. We recently used cluster tracking to analyze multiple incidents of Clostridium difficile infections, locating the care provider involved and reviewing the data in graph form.
Strategies to foster improved practices
With the routine data collection and analysis handled by the infection control monitor software, infection preventionists are free to translate evidence into practice. The first step is to be present on the hospital floor and connect with the front-line staff, who are often the end of the line for infection prevention policies. Being present allows infection prevention specialists to build relationships, as well as identify potentially problematic behaviors that never make it onto a patient’s electronic health record. Better relationships with stakeholders also facilitate delicate interactions, such as demonstrating data obtained via cluster tracking and encouraging changes in behavior.
Often, infection preventionists are required to further analyze a patient’s record. A central line-associated bloodstream infection may be the result of an improperly inserted line, or the fact that the patient was a heavy IV drug user. It is necessary to identify which HAIs are preventable before setting and implementing general policies.
A recent report estimated the cost of the five most common HAIs to the health care system alone to be $9.8 billion. With the CMS transferring that cost back to the hospitals, infection preventionists should not have any difficulty getting administrators and other stakeholders’ attention. Using automated surveillance systems not only improves awareness and data tracking, but also allows infection preventionists to identify and recommend specific changes, which result in improved patient outcomes.
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Disclosure: Wheeler reports no relevant financial disclosures.