Champions for success cover bases with infection control bundles

Healthcare Purchasing News, June, 2008 by Jeannie Akridge

All eyes are on infection control as hospitals anxiously await regulations soon to be enacted by the Centers for Medicare and Medicaid Services (CMS) in which they will no longer be reimbursed for certain hospital acquired conditions (HACs). Infection control practitioners and clinicians are stepping up to the plate and being applauded for their efforts to reduce rates of healthcare acquired infections (HAIs) and other preventable errors. They're helping to prove that reaching the elusive "zero infections" target is in fact attainable for extended periods of time, if not sustainable forever.

Leading infection control expert William Jarvis, M.D., who worked with the Centers for Disease Control and Prevention for 23 years, told Healthcare Purchasing News, "Depending on the patient population, getting to zero may be more challenging, but I think it really needs to be the goal for everyone. We have a number of studies now--out of Johns Hopkins; Michigan, where virtually all the ICUs in Michigan participated in the Keystone Project; as well as a number of hospitals that have participated in the Institute for Healthcare Improvement ([HI) collaborative--where they have been able to get their rate of central venous catheter related bloodstream infections in theft ICUs down to zero."

He added, "CMS has identified nine different conditions that they're not going to pay for as of October 1, unless they're present on admission. And one of them is vascular catheter related infections, so I think it is going to put a lot of pressure on hospital personnel to reduce these infections and reduce them not just in the ICU but in the hospital in general."

Mark E. Rupp, M.D., medical director of the department of healthcare epidemiology-infection control at the University of Nebraska Medical Center (Omaha) foresees that the CMS quality improvement measures will ultimately benefit ICPs. "I feel that the CMS reimbursement rules are helping to focus scrutiny on these infections. Many catheter-associated infections can be prevented and I think the CMS rule change is going to have a positive effect by reinforcing the preventive efforts that we're trying to spearhead."

David Parks, general manager, global business management, Kimberly-Clark Health Care noted, "With the ever increasing state level legislation and focus on mandatory reporting of healthcare-associated infections and the trends in pay-for-performance, I believe the role and objectives of the materials manager will change significantly over the next year or two. There will be a greater focus on investing in prevention solutions to reduce the costs associated with adverse events such as VAP and SSI."

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Experts agree that in order to survive in this new pay-for-performance environment, it will no longer be enough for hospitals to simply meet the status quo when it comes to quality and safety standards.

Kathleen A. McHugh, R.N., BSN, chief executive officer of the Association for Vascular Access, noted, "I think that the expectation that you go into a hospital and get an infection is based on the fact that we don't have high expectations. I'm not sure that zero is sustainable forever. People need to be constantly reminded to be hypervigilant," she added, "It's this lack of attention. Two hundred years ago we were told that washing hands would reduce 90 percent of all complications. And here we are in the year 2008 and all of a sudden hand washing is not being done on a regular basis."

David Shulkin, M.D., president and chief executive officer for Beth Israel Medical Center (New York City), credits early pioneers for efforts to help facilities move beyond accepted boundaries. "I think that there has been a mindset that frankly the University of Pittsburgh as one of the leaders helped break through. The way that clinicians had looked at things is that you look at the average and you try to be better than the average. Very few people had thought about the goal should be zero, not being below average. And I think that the University of Pittsburgh in not accepting the average scores but really shooting for zero, helped the industry have a mind shift in terms of, the goal should be zero."

"We're a top performing hospital nationally," noted Steve Lawler, president, Pitt County Memorial Hospital, Greenville, NC. "We're well within the 90th percentile, but that last 10 percent is the hardest. You try to reinforce that every patient is important to us so therefore we need to work extra hard to get to that Zero. I think that's what you shoot for. And even though it may be tough and it may be long in coming, that you're not satisfied until you get there and then once you get there you look for the next big thing."

Zero-barrier breaking success stories

HPN talked with several trend-setters who demonstrated what it takes to break the Zero barrier.

Sophie A. Harnage, BSN, R.N., has led her nursing team at Sutter Roseville Medical Center (SRMC), Roseville, CA, on a two-year winning streak of zero catheter-related blood stream infections (CRBSIs) with every patient who is managed by an innovative central line bundle. Her work, including details of the seven-practice bundle, was featured in the December 2007 issue of the Journal of the Association for Vascular Access (JAVA) (1).