AHRQ re­port finds qual­ity ef­forts on hospi­tal-ac­quired in­fec­tions not work­ing

Hos­pi­tals’ progress slow, re­ports says

Modern Healthcare - - Front Page -

In­creased aware­ness and newly spear­headed im­prove­ment ini­tia­tives have done lit­tle to curb the num­ber of health­care-as­so­ci­ated in­fec­tions, ac­cord­ing to a re­cent qual­ity re­port from HHS’ Agency for Health­care Re­search and Qual­ity. AHRQ re­leased its 2009 Na­tional Health­care Qual­ity Re­port on April 13 along­side a com­pan­ion re­port on health­care dis­par­i­ties, which to­gether “pro­vide a detailed snap­shot of how well the health­care sys­tem is do­ing,” said Carolyn Clancy, the agency’s di­rec­tor. It is the first time that the qual­ity re­port, now in its sev­enth year, has con­tained spe­cific tracking in­for­ma­tion about hospi­tal-ac­quired in­fec­tions, which af­fect nearly 2 mil­lion pa­tients each year, ac­cord­ing to HHS.

Us­ing CMS data, AHRQ found an 8% jump in the rate of post­op­er­a­tive sep­sis and a 3.6% in­crease in the rate of post­op­er­a­tive catheteras­so­ci­ated uri­nary tract in­fec­tions, sig­nal­ing a prob­lem that mer­its im­me­di­ate at­ten­tion, Clancy said. They also found no change in the rate of cen­tral-line blood­stream in­fec­tions.

But de­spite th­ese wor­ri­some fig­ures, it’s im­por­tant to keep them in con­text, Clancy said. “The in­for­ma­tion in that re­port only ap­plies through 2007, and a lot of it is Medi­care data,” she said.

In other words, those num­bers don’t take into ac­count the lat­est ef­forts by the gov­ern­ment and hos­pi­tals to make a sig­nif­i­cant dent in in­fec­tion rates, HHS Sec­re­tary Kath­leen Se­be­lius said in a con­fer­ence call.

For in­stance, in late 2009, HHS awarded $17 mil­lion to com­bat hospi­tal-ac­quired in­fec­tions. Nearly half that amount went to­ward a na­tion­wide ex­pan­sion of the Key­stone Project, an 18-month col­lab­o­ra­tive ef­fort be­tween Johns Hop­kins Uni­ver­sity, Bal­ti­more, and the Michi­gan Health & Hospi­tal As­so­ci­a­tion in Lans­ing, which low­ered the rate of cen­tral-line blood­stream in­fec­tions in more than 100 Michi­gan in­ten­sive-care units us­ing check­lists and staff train­ing.

The big­gest mo­men­tum will likely come from the re­cently passed Pa­tient Pro­tec­tion and Af­ford­able Care Act, which pro­vides in­cen­tives to adopt pro­to­cols aimed at re­duc­ing in­fec­tions, Se­be­lius said, and will even­tu­ally im­pose fi­nan­cial dis­in­cen­tives on providers that don’t lower their num­bers.

The in­fec­tion preven­tion land­scape has changed sig­nif­i­cantly since 2007, agreed Rick Foster, se­nior vice pres­i­dent for qual­ity and pa­tient safety at the South Carolina Hospi­tal As­so­ci­a­tion. The state’s in­fec­tion re­port­ing and tracking re­quire­ments have helped providers no­tice pat­terns and de­velop strate­gies, he said, and they have also moved away from the long-held no­tion that pa­tient safety ef­forts should be led only by qual­ity im­prove­ment staff.

“In our state, we’ve seen hos­pi­tals that have made in­fec­tion preven­tion the re­spon­si­bil­ity of the whole unit,” Foster said. “That’s a big tran­si­tion from the old, siloed ap­proach. Now we have en­tire in­ten­sive­care units that are work­ing to­gether to pre­vent cen­tral-line in­fec­tions.”

In fact, Foster cred­its that team-based ap­proach with help­ing to achieve a nearly 45% drop in the num­ber of cen­tral-line blood­stream in­fec­tions

Joyce: Sys­tem tar­gets two goals in hopes of mak­ing strides.

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