IPs to “making their business case” but should work with
them to collaboratively develop the best human, IT and
financial resources to elevate their organizations to best in
class. IPs provide crucial institutional oversight by developing
policies, maintaining surveillance and complying with
regulations required for CMS funding and accreditation.
They use their extensive knowledge, skills and abilities to
assist in determining potential root causes of infectious
outbreaks with quick notification to county, state and other
agencies such as CDC. The investigation of sink drains,
faucets, ice makers, water holding tanks, showers, air
circulation patterns and other potential sources that harbor
organisms is meticulously coordinated by IPs. Finally, IPs act
as internal advisors related to their organizations’ compliance
to requirements and guidelines by OSHA, NIOSH, EPA, TJC,
CDC, and other agencies.
GG: The CDC reports there are approximately 90,000
deaths each year related to healthcare-associated infections
(HAI), with 1 in 25 people in the U.S. who get this type of
infection. HAIs contribute to prolonged hospital stays and
increased healthcare costs, ranging from $28 billion to $45
billion in estimated annual hospital costs. The role of the IP
is crucial to help identify best practices to be incorporated
into evidence-based guidelines. Their role provides the ability
for surveillance and monitoring the infections to not only
contribute to the care of the patient, but provide insight
for the staff on infection prevention protocols. The IP is
engaged in all aspects of patient care, including perspectives
of laboratory, environmental and pharmaceutical. The IP
provides important data for the hospital C-suite to understand
the impact of infection control measures on improving
patient outcomes.
HB: There are a couple of aspects to a successful business
case model. One is trying to tie it directly to cost savings
and also the overall benefit of having a program that is
strong enough that at the facility can meet quality targets
and does not get penalized through CMS — or any other
organizations — on overall performance of those quality
metrics. It is helpful to keep those outcomes in mind and the
cost impact of having high rates of infections and potentially
having a CMS penalty in terms of lack of reimbursement
to the hospital.
HHM What role can value analysis professionals play
in helping infection preventionists make the business
case for HAI prevention?
BS: Value analysis programs should include infection
preventionists in the review and decision-making process for
equipment and supplies that will come into contact with
mucous membranes or nonintact or intact skin, paying close
attention to reusable devices that will need to be cleaned,
disinfected and/or sterilized between uses on the same or
another patient. Reusable instruments and endoscopes have
been implicated in resistant bacterial outbreaks. Soaps,
lotions, and other hand hygiene products, gloves, sharps
safety, regulated medical waste containers and practices,
surface cleaning wipes and products for care of environmental
surfaces are among the most crucial decisions that require IP
guidance, review and approval. Value analysis professionals
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are keenly aware that institutional decisions that could result
in a change of urinary and indwelling vascular catheters,
peripheral IVs, as well as practices related to insertion,
maintenance and dwell times of catheters, ET and feeding
tubes, and other devices must come under the purview of IPs
who assure the rate of HAIs do not increase or may provide
other mechanisms to potentially prevent them.
GG: Value analysis professionals play a significant role
in helping IPs make the case for HAI prevention especially
regarding new and or existing products or equipment used
within healthcare organizations. IPs are typically included in
the value analysis process, so they are able to evaluate the
products or equipment to determine its potential effect on
healthcare-acquired infections. Their expertise is used to
help guide decisions especially around products or equipment
that could impact the closely monitored infection rates such
as CAUTI, SSI, CLABSI, etc.
HHM How can the hospital epidemiologist help the
IP with making a business case for infection prevention
and control?
HB: There is literature available that tries to estimate
costs associated with individual infections, and so the
epidemiologist and the infection preventionist can work
together to approach the hospital leadership. And then the
epidemiologist, as the infectious disease physician, can also
bring that clinical personal perspective to the business case
as well, and provide examples from their own experiences of
patients who’ve had bad outcomes, the long-term sequelae
of having an infection or dying from a central line infection.
And sometimes though in theory, the business case should
be all about numbers, and not about those personal stories,
sometimes those personal stories can serve as a good hook
to reach people and get them more engaged.
HHM How open are today’s hospital leaders to the
business case for infection prevention and control?
HB: I want to say they are all very open to it, but I think
it is probably variable across facilities and across regions
and it remains a challenge. The financial situation around
healthcare in this country remains very complicated, and the
way that payment comes in and goes out and is allocated
makes it difficult to directly attribute cost savings to areas
where prevention work is conducted, and the silos of
budgeting and payment models that complicate matters.
If you think big-picture and long-term, there is increasing
pressure from third-party payors and increasing pressure and
interest in paying for the overall cost of care, of insuring
a life over time and doing that by lump-sum payment
to a healthcare system or to a facility or to an insurance
company. And I think to the extent that that continues to
move forward, it can help infection prevention more than
a more traditional full fee-for-service model. We know that
stopping payment for complications definitely ups the ante
on being able to determine what types of infections are
preventable and what are not. I do hope hospitals are truly
contemplating and appreciating the value of their infection
prevention programs.
february 2020 • www.healthcarehygienemagazine.com