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How well can we control healthcare-associated infections (HAIs)?

October 12, 2012
by Pamela Tabar, Associate Editor
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methicillin-resistant Staph. aureus

Quality initiatives that reduce reimbursements for high infection rates have gotten a lot of publicity lately, but are they having any success in curbing infections? Yes, no and maybe—according to several studies published in prominent journals this month.

The University of Pittsburgh researched the effectiveness of coordinated infection control among area facilities, specifically for methicillin-resistant Staphylococcus aureus (MRSA), which can spread rapidly as patients transfer from hospitals to skilled nursing facilities or other care sites.

The study used data from all 29 hospitals in Orange County, Calif., an area that has a deeply interwoven system of patient transfers and readmissions, the authors noted. Researchers then created computer scenarios based on the real-life data where some facilities implemented “contact isolation” procedures to control MRSA infection rates and others did not. Hospitals that implemented contact isolation lowered their own infection rates and the rates at nearby facilities, according to the study, published in the October issue of Health Affairs journal.

More people die from healthcare-associated infections (HAIs) than from breast cancer, AIDS and auto accidents combined.
Source: www.onthecuspstophai.org

The biggest winners were long-term care facilities, which saw a 12 percent decrease in MRSA infections when the hospitals enacted contact isolation procedures, the authors found.

In another study, published in this week’s New England Journal of Medicine, researchers examined the impact of the 2008 Medicare reimbursement reductions for preventable infections on the rates of central line-associated blood stream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Using data from 398 hospitals in 41 states during 2006-2011, the study compared infection rates before and after the 2008 introduction of Medicare’s payment reduction policy.

Hospitals saw “no significant changes” in the rates of CAUTIs, CLABSIs or ventilator-associated pneumonia after the 2008 policy had been implemented, though the authors said it is unclear whether the results are related to the policy’s limited impact or the hospitals’ own prevention efforts prior to 2008.

Despite the question of impact, most clinical and patient-safety organizations support infection-reduction efforts from a best-practices approach. Hospitals that do not get their infection rates under control may see double jeopardy by 2015, when Medicare’s upcoming penalty policy for high infection rates joins the federal agency’s current penalty phase for hospital readmissions.

CLUBBING CLABSIs

Hospitals encounter about 250,000 CLABSIs each year. Approximately 62,000 patients will die from one.

The Comprehensive Unit-based Safety Program (CUSP) program, which grew out of several state infection-reduction projects, has seen much success across the country, particularly in curbing rates of central line-associated blood stream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI).

The national CUSP initiative offers multi-module toolkits to guide facilities through the steps to prepare for and enact the CUSP program, including training materials, video segments, peer-to-peer coaching tools and presentation slides. The toolkits are available on the Agency for Healthcare Research and Quality website.

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