healthcare value analysis
By Barbara Strain , AM , SM ( ASCP ), CVAHP
Value Analysis Keeps an Eye on Surgical Site Infection Prevention
The Centers for Disease Control and Prevention ( CDC ) published a report last year that found healthcare-associated infections ( HAIs ) increased significantly in 2020 . 1 This was emphasized by a paper in The New England Journal of Medicine that cited studies on impact of patient safety and infection control by the pandemic . 2 An all-hands-on-deck approach in the early high surge was accompanied by successive surges of high acuity and sheer numbers of patients which stressed the staffing infrastructure , compounded the already-busy daily routines of infection preventionists , and required the pivot to alternate PPE , raw materials to make disinfectant wipes , and other decisions that could disrupt the pre-COVID infrastructure .
In contrast to these negative findings that found HAIs increasing in the face of steady efforts that lowered these quality indicators from 2015 baselines , the refreshing news is the processes , policies , practices , and products that were implemented , worked . While the full impact of SARS-CoV-2 on HAIs is not yet fully known , the quarterly surveillance during the pandemic was affected by the implementation of the extraordinary circumstance exception ( ECE ) policy by the Centers for Medicare & Medicaid Services ( CMS ) which excused facilities from HAI surveillance and reporting . 3 Despite the ECE policy , up to 88 percent of acute-care hospitals reported results for some HAIs as a category but a larger number did not report in the surgical site infection ( SSI ) category . Caution is to be heeded in interpreting HAI data starting in 2020 .
Value analysis is a proven process that relies on a ) clinical-based evidence , data collection – electronic medical record , surgical records – as well as purchasing , finance , infection control measures , quality , safety , risk management ; b ) synthesizing analytics ; c ) preparing executive summaries for decision making ; and d ) if approved , participates in successful implementation ; and e ) monitors results to assure the decision proved out . Value analysis professionals are the frontline , risk-avoidance watchmen , using what is the equivalent of a giant checklist .
When considering whether new or current products or services will not adversely affect HAIs ( CLABSI , CAUTI , VAP ) or healthcare-acquired conditions ( HACs ), falls , or HAPI , one can appreciate how products may directly affect these outcomes . From antibiotic-coated central line catheters , packaging to standardize insertion , dressing change kits , yellow gowns and alert signage , therapeutic support surfaces , lift equipment as tangible mitigation tactics . SSI rates are in their own category . For example , during 2020 , 2021 and early in 2022 , SSI-rate accuracy was compounded by the overall decrease in surgical procedures then rollercoaster efforts to relieve the case backlog .
The complexity involved in acquiring SSIs is multifactorial ; human , physical , environmental , instrument processing , policies , programs , and compliance ( e . g ., SCIP-Surgical Care Improvement Project ), antibiotic stewardship , basic infection prevention interventions such as hand hygiene , and the list continues . 4
In 2019 the CDC reported there were 157,000 annual SSIs and 1 million added patient days at an estimated cost to the healthcare
When reviewing specifications of products or services , value analysis assures that suppliers are asked , “ Will your solution have an impact on our HAI , HAC or other quality indicators ?’ If they say yes , they are required to submit peer-reviewed literature , reference provider end user organization contacts , along with internal science development . In some instances , the product or service is so new that peer-reviewed literature may not exist . If an organization finds still finds merit in a product or service , it may decide to conduct a study or evaluation to collect information to support making an informed decision .
For products in the operative environment , it is more complex ; onboarding one product or service may disrupt a practice that has already resolved one of the conditions related to acquiring an SSI . An example is equipment that produce that effect the operating room ( OR ) environment by changing air flow or creating temperature imbalances or cannot be accommodated safely in the space and may create a hazard .
In addition to the OR director , service line nurse managers , surgeon champions , and anesthesia perioperative value analysis teams should include a director or manager from the sterile processing department ( SPD ). Decisions for processing equipment , detergents , high-level disinfection agents , prep and pack materials like instrument pouches and quality control process check materials should be discussed by the team .
One state patient safety advisory stated “… there is evidence of infection transmission when cleaning and sterilization procedures have not been adhered to , or where quality control has been poor …” 6 Surgical instruments and procedures have become more complex , with torturous paths , moving parts and other nooks and crannies where bone , tissue and blood can get trapped , it ’ s important to have the SPD voice at the table . 7
Other products or services focus on either tracking who may not be hand sanitizing at every possible opportunity as tasks are completed near the patient / operative fields ( e . g ., line care or hand sanitizer devices that are attached to individuals that make it convenient to use and also provide tracking reports ).
Despite what is going on in our healthcare environments inclusion of value analysis processes in critical decision making may make the difference in patient safety outcomes .
Barbara Strain , AM , SM ( ASCP ), CVAHP is a founding member and strategic board liaison for the Association of Healthcare Value Analysis Professionals ( AHVAP ).
References :
1 . https :// www . cambridge . org / core / services / aop-cambridge-core / content / view / 8197F323F4840D233A0C62F4726287E1 / S0899823X21003627a . pdf / the-impactof-coronavirus-disease-2019-covid-19-on-healthcare-associated-infections-in-2020-asummary-of-data-reported-to-the-national-healthcare-safety-network . pdf 2 . New Eng J Med . Increase Infections 2022 . pdf 3 . CMS . ECE 4 . http :// www . ihi . org / resources / Pages / Changes / ChangestoPreventSurgicalSiteInfection . aspx 5 . https :// www . cdc . gov / nhsn / pdfs / training / 2019 / ssi-508 . pdf 6 . http :// patientsafety . pa . gov / ADVISORIES / Pages / 201706 _ 71 . aspx 7 . https :// www . infectioncontrolresults . com / sterile-processing-changes
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