Wednesday, August 6, 2008

Actions Addressing HAIs

Richard A. Van Enk, Ph.D, Director, Infection Control and Epidemiology, Bronson Methodist Hospital in Kalamazoo, Michigan speaking at the 2nd Annual Public Health Care Congress, said “5% of all hospitalized patients develop an infection in the hospital that they did not have on admission.”

It is possible to reduce these hospital acquired infections according to Dr. Van Enk. For example, hospitals can significantly reduce the risk of Ventilator Associated Pneumonia (VAP). The Keystone initiative, funded by a group of payers and the Michigan Hospital Association developed interventions to reduce the risk of VAP.

Some of the VAP interventions need to provide the appropriate sedation, keep the patient’s bed elevated, provide for a daily spontaneous breathing trial, provide tight glucose control, and track goals and compliance. However, according to Dr. Van Enk, each element requires the healthcare team to do something new and extra and there may be resistance or non-engagement from physicians and nurses.

He continued to say “the good news is that the Bronson Methodist Hospital VAP rate has decreased following implementation of the VAP interventions and went 31 months without a VAP. Although we still have VAP cases, the incidence has decreased and we feel that we are now doing everything possible to reduce the risk of VAP.”

In addition, there are other projects underway. Using fast track funding by AHRQ, five research collaboratives with over 70 academic medical centers, community hospital systems, and other healthcare organizations across the U.S. are investigating various strategies to prevent infections.

The Indiana University School of Medicine, the Regenstrief Institute, Inc., the Roudebush VA Medical Center, and the Indiana University-Purdue University Indianapolis School of Engineering and Technology are working together as a national resource center to prevent hospital acquired infections.

The team is using their expertise in evidence-based medicine, informatics, and systems engineering to help determine best practices and how to implement these practices at hospitals large and small, urban and rural, and public and private.

Over the next 18 months, the team consisting of researchers, systems engineers, informaticists, infectious disease experts, and doctors and nurses will help collect data in forms so that the team can effectively evaluate the different approaches to infection control at the 72 healthcare institutions that are being studied. The ultimate goal is to share lessons learned about successes, barriers, and challenges and then implement and maintain strategies to help decrease hospital acquired infections.

In addition, starting October 1, 2008, Medicare and Medicaid will not pay hospitals for some medical care made necessary by adverse events. For example, after that date, Blue Cross Blue Shield of Michigan and the Blue Care Network policy on reimbursement for serious adverse events will not pay hospitals for objects left in a body after surgery, air embolism as the result of surgery, blood incompatibility, equipment associated infections, advance pressure sores, and hospital acquired injuries such as falls.