An estimated 90,000 people die in the U.S. each year because of hospital-acquired infections (HAIs) — also called nosocomial infections — and of those about 50,000 deaths are due to methicillin-resistant Staphyloccus aureus (MRSA) bacteria. And it is thought that 2 million HAI cases add between $7 billion and $30 billion to the nation’s healthcare bill each year.
The “good news,” according to VHA (Irving, Texas), a healthcare alliance of non-profit hospitals, is that studies have shown that these healthcare associated infections are largely preventable.
Toward that end, VHA is launching a national initiative to reduce and eliminate HAIs over the next three years. The HAI initiative will focus on several clinical initiatives: preventing central line infections; preventing surgical site infections; preventing ventilator-associated pneumonia; improving hand hygiene, isolation and barrier precaution; implementing active surveillance methods; and making behavior, cultural and organizational changes at facilities.
Of VHA’s 2,400 member facilities, 1,400 are hospitals, and it is widely known that going into a hospital risks an infection is that is serious — or even deadly.
Betty Wilson, RN, director of clinical performance at VHA, told Medical Device Daily that all of VHA’s members are affected by this issue and the company’s. Wilson said that it has studied those hospitals in the alliance that have been most successful in fighting infection.
“We are strong believers in evidence-based medicine,” Wilson said. “We can see, through data, where the problems are and look to the better performers, basically to look at what they’re doing.” And Wilson said that better data concerning the problem typically reveals better procedures.
“If their numbers are better, then obviously they have a process that is working in their culture — that better practice, and that evidence-based medicine through the whole area, and [then] each area can basically modify [those processes] to suit their hospital’s culture,” Wilson said. She noted that this is an approach that doesn’t require “reinventing wheels.”
One collaborative that already is underway focuses on eliminating MRSA bacteria, a problem in healthcare facilities for about 30 years, Wilson noted.
The national initiative involves engaging VHA members in regional collaboratives to help them and track their performance. VHA will help hospitals develop new ways to team with peer organizations, share best practices, measure and benchmark performance and learn from MRSA experts.
Through the use of evidence-based interventions, effective coaching, measurement tools and best practice sharing, hospitals can improve their clinical and economic performance relative to HAIs, VHA said, and so it is sponsoring several clinical improvement initiatives to help its members approach HAIs in different arenas over the next three years.
Several existing VHA programs already have generated strong results, the company said, such as the “Transformation of the Intensive Care Unit (TICU) Program.”
Intensive care units (ICUs) have the highest incidence of HAIs, and VHA said that participants in TICU have dramatically decreased their incidence of HAIs by changing the way they deliver care. The program provides participants with tools and methodologies, training and guidance and the necessary measurement tools.
By focusing on a set of simple techniques proven to improve patient outcomes and using the tools provided by TICU, Hartford Hospital (Hartford, Connecticut) reported reducing by half its nosocomial infection rates in its medical intensive care unit (MICU) — putting it in the 15th percentile nationally. Other improvements experienced between July 2002 and March 2004 included: decreased average length of stay by 8%; decreased adjusted costs by 3%; increased admissions by 9.5% (because of more available beds); and 13% in increased MICU revenue.
The organizations that VHA is working with include the Centers for Disease Control and Prevention (Atlanta), theJoint Commission on Accreditation of Healthcare Organizations (Oak Brook, Illinois) and the Centers for Medicaid & Medicare Services , their collaboration intended to avoid competing against each other’s efforts to fight the same problem, Wilson said.
“In the past, we’ve had some very good partnerships with a lot of industry leaders on infection control,” Wilson said. “And we’ve been able to work with them in different areas [such as] cardiovascular through different infection problems. Those relationships have been established and we’re just broadening them at this point.”’
The first coordinating council meeting organized by VHA on HAIs convened in September, and another meeting of the group will be held next week.
“We want to work together so that we can help more patients in improving what I call an epidemic,” Wilson said.
VHA also will sponsor programs at the state, regional and national levels over the next three years to emphasize the importance of this movement to eliminate hospital-acquired infections, including:
- work on techniques to identify quickly the type and source of HAIs: MRSA, Vancomycin-Resistant Enterococci (VRE),Clostridium difficile (C. diff.) and Legionella;
- improve pneumococcal pneumonia/influenza immunization access ;
- disseminate education on the proven practices that help reduce the likelihood of HAIs, such as optimal device management, employee vaccination, glycemic control amd wound care;
- broaden HAI educational opportunities via web-based initiatives and satellite broadcasts;
- work with members to better manage antibiotic usage, which contributes to the development of resistant bacteria;
- and work on data collection, reporting and improving benchmark methods.
“Hospital-acquired infections signal that less than optimum care is being provided, and we’ve got to raise the bar,” said Ken Smithson, MD, VP of research at VHA. “It’s the right thing to do for patients, and it has a significantly positive impact on a hospital’s bottom line.”