When someone is admitted into the hospital, the patient counts on personnel to help them get well. However, there is always a chance they can contract an infection while at the hospital.
Most infections can be treated successfully while others may be life-threatening. About 75,000 people die each year from hospital-acquired infections, and these infections cost the country nearly $10 billion annually.
The good news is hospitals are making progress in reducing these infections. In Texas, central line-associated bloodstream infections (CLABSI), methicillin-resistant Staphylococcus aureus (MRSA), C. difficile and surgical site infection rates have declined. However, Texas hospitals continue to see higher rates of catheter-associated urinary tract infections (CAUTI) than the national baseline.
All but one East Texas hospital was safe from the first round of penalties under a new requirement that docks providers for high hospital-acquired infection rates. ETMC Jacksonville is seeing a 1 percent reduction of its Medicare payments for FY2015, ending in September.
In December, we first learned 721 hospitals, including 43 in Texas, with the highest rates of infection would be penalized, as required in the Affordable Care Act. These penalties are part of performance-based measures, aimed at improving outcomes and saving dollars. The three examined in this cycle are: CLABSI, CAUTI, and serious complications. The Centers for Medicare and Medicaid Services (CMS) graded the three measures on a scale from one to 10 and got an average. Hospitals with a total score higher than seven were penalized. ETMC Jacksonville scored a 10.
Data from 2012 to 2013 was used to determine penalties and the reductions from the penalties amount to $373 million.
Administrators said smaller hospitals might have a tougher time, as infection control is labor intensive — making use of additional people, equipment and supplies. ETMC Jacksonville also has less volume than their larger counterparts, which doesn’t leave much room for error when calculating infection rates.
“In 2012, we had one Foley catheter-associated urinary tract infection involving one patient,” said Debbie McCaslin, a registered nurse and director of quality improvement and infection control at ETMC Jacksonville. “For 2013, we had three and of those, two of them were on the same patient who stayed for a really long time. So really, there were only three patients involved that had infections but because our numbers are small, it makes our rate high.”
All hospital administrators say CAUTIs are the most challenging infection to tackle. It’s a common procedure, particularly for nursing homes, quadriplegic and trauma patients. In these instances, an infection may already be brewing.
“Key to avoiding the attribution of infection to a hospital is to identify it at admission,” Miranda Pierce, an infection control nurse at ETMC Tyler, said
While ETMC Tyler was not penalized last October for infection rates, the most current data, reported in April, shows that ETMC Tyler’s CAUTI rate is worse than the national benchmark. The data is from July 2013 through June 2014. ETMC officials say they’ve seen some improvement since October.
“We have been able to demonstrate that we have not had a UTI in six consecutive months now,” said Ralph Carroll, quality officer at ETMC. “We can demonstrate that we’ve reduced the use of catheters by 20 percent.”
The hospital utilizes infection prevention control nurses and has adopted new protocols and technology to help reduce infection rates, but it revisits evidence-based science that has been set.
“We are ensuring we are carrying out that same evidence,” said Vickie Robinson, director of nursing quality at ETMC Tyler. “It’s not that we’re trying to create something different.”
The best way to prevent these infections is to be selective when inserting a catheter in the first place.
“You want to only do it when medically necessary, where we used to do them routinely — and most hospitals did,” Ms. McCaslin said. “Now we are more selective in patients we use catheters with.”
This also means a patient or a patient’s family member thinking twice about requesting a catheter if the person is mobile, and being vigilant about personal hygiene, as a catheter is a great opportunity to introduce bacteria into the body.
“It’s about changing the culture and mindset of not just the physicians and nurses, but patients and family members, too,” Ms. Pierce said.
NEW MEASURES TO COME
With more scrutiny from CMS and with hospitals standing a chance to lose a lot of money, hospital officials say they must stay ahead — aiming for zero infections.
“You have to be proactive instead of reactive,” Bonnie Brown, administrative director of quality management at Trinity Mother Frances Hospitals and Clinics, said.
Mother Frances Hospital has managed to buck some nationwide trends. The most current data shows it fares better than the national benchmark in two areas: CLABSIs and CAUTIs.
Good hygiene is the key to eliminate infections, Ms. Brown said. Simple hand washing and sanitized areas are vital. This also includes patients and visitors, as it’s easy to spread germs on hands.
“We should be more vigilant and aware of how easy it is to spread these bugs,” she said.
While progress has been made on most fronts, hospital-acquired infections are still a concern for patients and health care workers.
“A lot of work needs to be done across the country,” Ms. Brown said.
CLABSIs, CAUTIs, and serious complications will continue to be assessed annually. In October, the federal government will add surgical site infections. The following year, hospitals will be evaluated for C.difficile and MRSA infections.