2008 through 2010 was the greatest movement in the passage of HAI laws due to attention drawn to it on the legislative front and ARRA funding which pumped in federal dollars into the state HAI programs .”
— Julie Reagan , PhD , JD , MPH
to it on the legislative front and ARRA funding which pumped in federal dollars into the state HAI programs ,” Reagan says . “ From 2010 to the present , a handful of states joined the bandwagon to enact laws , but most of the changes came in the form of amendments to existing statutes and creation and amendments to HAI administrative rules . As the state HAI programs have identified shortfalls and problem areas , they have adapted their administration rules in response . Also , once CMS started requiring reporting from Medicare-certified facilities , the state-level legislative activity pretty much ceased . States essentially acknowledged , ‘ The feds are in control now .’”
Acute-care hospitals , among other healthcare facilities , were required by CMS to report data to the NHSN to fulfill CMS ’ s Hospital Inpatient Quality Reporting ( IQR ) requirements , which also became tied to Medicare and Medicaid reimbursement . But surveillance wasn ’ t always tied primarily to dollars and cents .
As Dixon ( 2011 ) explains , “ During the 1950s , epidemic penicillin-resistant Staphylococcus aureus infections , especially in hospital nurseries , captured the public ’ s attention and highlighted the importance of techniques to prevent hospital-acquired infections . By the mid-20th century , some surgeons , microbiologists , and infectious disease physicians had focused their studies on the epidemiology and control of HAIs . From the efforts of these pioneers grew the notion that hospitals had the ability — and the obligation — to prevent HAIs . By the 1960s , hospital-based infection control efforts had been established in scattered hospitals throughout the U . S . The number of hospitals with HAI control programs increased substantially during the 1970s , and HAI control programs were established in virtually every U . S . hospital by the early 1990s . The remarkable spread and adoption of programs designed to prevent and control HAIs hold valuable lessons about the ways that other public health initiatives can be designed , developed , and implemented . This report traces the strategic and tactical steps used to bring about a major public health success : the ubiquity of formal established infection control programs in virtually all U . S . hospitals and expanding into other healthcare settings .”
The public health model for hospital infection prevention and control started gaining traction in the 1960s , Dixon ( 2011 ) says , noting that , “ A small proportion of hospitals had begun to implement programs designed to understand and control HAIs . The pioneering leaders of those efforts were located mostly in large , academic medical centers , not in public health agencies . Although state , local and federal public health agencies were sporadically called on to provide epidemiologic or laboratory support to investigate particular problems , they did not consider hospitals as communities needing ongoing public health resources . Nor did hospitals routinely see themselves as communities needing such assistance .
During the 1950s and even afterwards , many hospitals saw themselves as ‘ the doctor ’ s workshop ’ and their roles as providers of space and personnel to support practicing physicians . In most communities , a hospital was perceived as good because doctors who practiced there were perceived as good , not because the hospital ’ s outcomes were better than its competitors ’. Focused on patients and doctors as individuals , most hospitals neither tracked nor had systems in place designed to improve their overall outcomes ; public health-based and population-based principles often were not important management priorities . The nosocomial staphylococcal epidemics of the 1950s began to change those attitudes . History did not record who first understood — or when it was first recognized — that hospitals are discrete communities in which public health principles could be used to prevent and control HAIs . But by the 1960s , hospital-based clinicians and CDC epidemiologists clearly were beginning to apply a public health model to HAIs . That model was built around systematic surveillance to identify HAIs ; ongoing analysis of surveillance data to recognize potential problems ; application of epidemic investigation techniques to epidemic and endemic HAIs ; and implementation of hospital-wide interventions to protect patients , staff , and visitors who seemed to be at particular risk .”
By the late 1970s , it is generally accepted that the infection control field was decently established . As Dixon ( 2011 ) explains , “ It had strong presences in hospitals across the country , organized workforces , a coherent model that guided the field ’ s activities , and a rapidly expanding body of scientific publications . A decade earlier , during the late 1960s and early 1970s , however , that degree of success was not certain . During the early 1970s , the hospital infection control movement faced the same challenges as many other public health initiatives have before it : how to increase adoption by more communities and how to convert a good idea into a virtual mandate for action .”
By the mid-1970s , HAIs were recognized as a major threat associated with medical care . As Dixon ( 2011 ) points out , “ Despite the increasing public and professional concern about HAIs , it became apparent during the mid-1970s that not all hospitals were adopting infection control programs . CDC had ready access to national professional societies , healthcare trade associations , accrediting organizations , and regulatory agencies , but infection control programs , although encouraged , were not mandated . Some hospitals had no programs at all . Other hospitals had programs , but no requirement existed to ensure they were properly staffed , well structured , or effective . The absence of a requirement that hospitals have effective infection control programs to protect the public was due , in part , to the fact that the evidence for the effectiveness of the public health model for infection control programs was mostly only anecdotal .