“Are you sure you washed your hands?” If you thought these are words only spoken by a mother to her child, you would only be half-right. According to the Centers for Disease Control and Prevention, each year, 1.7 million Americans become ill because of hospital-acquired infections (HAIs), which include blood infections related to central lines, urinary catheter-associated urinary tract infections, mechanical ventilator-associated pneumonia and surgical site infections. In addition to the physical toll this exacts on the patient, it is estimated that HAIs cost $45 billion annually. Let’s break down the numbers down a bit:
- Three hospitalized patients are infected every minute
- 180 hospitalized patients are infected every hour
- In the time it took you to read this – rub your eyes in disbelief and re-read these alarming statistics – three new patients contracted HAIs
In a coordinated effort to reduce the HAI rate, federal agencies (like CMS and The Partnership for Patients), patient-advocacy groups (including AARP, NACHRI and Safe Care Campaign) and healthcare providers have launched campaigns aimed at preventing these avoidable and costly infections. The simple reminder to “wash your hands” can be seen on posters and heard echoing throughout the halls of hospitals, rehabilitation facilities, physicians’ offices—any location where patient care is provided. And while the focus of research studies has been primarily on acute care, no one should misconstrue this to mean that this is the only HAI channel in the healthcare continuum. It is just more difficult to monitor and collect data from the many other service providers within the healthcare industry currently. However, as we move toward a population health environment, this will and should be the expectation of patients, providers and payers alike.
Hand washing before and after every patient encounter is projected to decrease HAI incidences by an estimated 40 percent or roughly 36,000 patients annually. Yet, industry and hospital surveillance surveys continue to report that compliance rates are spotty and this remains one of the most difficult provider behaviors to change. What is capturing the attention of healthcare providers are the Medicare financial penalties that will impact reimbursement for all Medicare intake, not just those providers who are identified as having high HAI rates.
The Joint Commission and CMS quality measure sets enable these agencies to collect data on many facets of the care-related HAI conditions. Poor performance can impact accreditation as well as CMS remuneration. In fact in 2008, CMS announced they would not pay hospitals for “never events,” or events that they could argue should have never occurred in the first place. In addition to the financial impact, the reputation damage caused by HAIs cannot be underestimated. Quality metrics, physician report cards and patient satisfaction surveys are enabling patients to become true consumers of health care.
It has been ten years since the Institute of Medicine published the frequently discussed “First Do No Harm” study, and while the statistics do not necessarily support the concerted efforts made in healthcare to mitigate all the risks of HAIs, some strides have been made. Through the use of quality measure performance, performance analytics and clinical surveillance tools, healthcare providers can continually monitor trends at numerous levels – including the patient populations they serve, physician performance, nursing unit performance and readmission rates. This allows them to better identify and address at-risk situations. Central to this strategy is the use of clinical documentation improvement (CDI), which ensures that any patient conditions that are present-on-admission are identified and documented, including those that might otherwise have been miscoded as HAI. Through the use of Clinical Language Understanding (CLU) technology and narrative search, infection control practitioners can quickly identify those patients who may be at risk for HAI.
For those who are skeptical that HAIs have become a national healthcare crisis, I ask you to consider this: more patients die annually from HAIs than from AIDS, motor vehicle accidents and breast cancer combined. Thanks to new quality reporting metrics and data submitted to CMS, which is publicly available on Hospital Compare, consumers and watchdog agencies are paying attention to who has and who has not been washing their hands.
For more insight on best practices aimed at ensuring the quality of patient care, be sure to check out this August 6 webinar with Barnabas Health: Protecting The Patient and Your Bottom Line Using Process- Driven Metrics: Barnabas Health’s Keys to Success.