RSSAll Entries in the "Infection Control" Category

Multidrug-resistant infections can cost $4,600 per hospital stay

By Christopher Cheney, HealthLeaders Media

Infections linked to multidrug-resistant organisms (MDROs) cause a significant cost burden for U.S. healthcare, recent research shows.

The development of antibiotic-resistant infections is one of the most severe public health problems in the country, according to the Centers for Disease Control and Prevention. About 23,000 Americans die annually from an antibiotic-resistant infection, the CDC says.

The national price tag for treating infections linked to MDROs in the hospital setting is at least $2.39 billion, according to the recent research, which was published in the journal Health Services Research.

The researchers also tallied the treatment cost per inpatient hospital stay for methicillin-resistant Staphylococcus aureus (MRSA)Clostridium difficile (C. difficile), and other MDROs.

  • Treatment of infection with MRSA cost about $1,700
  • Infection with C. difficile cost about $4,600
  • Infection with another MDRO cost about $2,300
  • Infection with multiple MDROs cost about $3,500

“We find the highest incremental and total costs for C. difficile and the lowest incremental costs for MRSA, consistent with estimates from previous reports. The higher costs appear to be driven largely by a higher average length of stay, but may also be due to additional testing and increased risk for ICU admission with C. difficile,” the researchers wrote.

In 2014, the President’s Council of Advisors on Science and Technology made several recommendations to combat antibiotic resistance, including surveillance of MDROs in healthcare settings and the community, anti-microbial stewardship campaigns, precautions to limit exposure, and education of patients and physicians about the dangers of overprescribing antibiotics.

Calculating superbug economics

The lead author of the Health Services Research article, Kenton Johnston, PhD, MPH, told HealthLeaders that determining the cost effectiveness of efforts to reduce MDRO infections is challenging.

“Essentially, you are comparing the costs of MDRO-reduction efforts to the savings generated by those efforts. The costs of MDRO-reduction efforts would be the programmatic costs of interventions. This is tricky because the interventions are wide-ranging throughout society such as hand-washing campaigns. The savings part is also tricky because the savings also accrue throughout society,” said Johnston, an assistant professor at the College for Public Health & Social Justice, St. Louis University.

Johnston’s research team only examined hospital costs of efforts to combat MDRO infections.

“A systematic review of the literature on just the cost side of this equation found that the cost of measures to combat and eradicate MDROs ranges from $331 to $66,772 per MDRO-positive patient. This is obviously an unacceptably huge range for calculating the cost side of the equation alone. As a result, more research needs to be done,” he said.

Cost of sepsis readmissions exceeds $16,000 per patient

By Christopher Cheney, HealthLeaders Media 

The annual estimated cost of sepsis readmissions is about half the annual cost of all four of the conditions in Medicare’s Hospital Readmissions Reduction Program, recent research shows.

“In our study, the estimated annual cost of sepsis readmissions amounted to more than $3.5 billion within the United States. When compared to $7.0 billion for the four conditions (AMI, CHF, COPD and pneumonia) targeted by the Hospital Readmissions Reduction Program (HRRP), this accounts for a significant under-recognized burden on the U.S. healthcare system,” the researchers wrote in the journal CHEST.

Sepsis is the body’s extreme reaction to an infection, which can result in life-threatening symptoms such as multiple organ failure. Annually, more than 1.5 million people get sepsis in the United States, with about 250,000 fatalities.

The economic impact of sepsis on a national scale is significant, the CHEST researchers found in their study, which featured more than 1 million index admissions.

  • The annual cost of index admissions for sepsis was estimated at more than $23.3 billion
  • The mean cost per sepsis readmission within 30 days of discharge was $16,852
  • 30-day readmissions after an index admission for sepsis accounted for 13% of all sepsis-related hospitalization costs

The lead author of the CHEST research, Shruti Gadre, MD, told HealthLeadersthat sepsis readmissions are likely expensive because of intensive care unit treatment, antibiotics administration, and invasive procedures.

Sepsis readmissions are expensive relative to the HRRP conditions most likely because of the acuity of sepsis patients, said Gadre, a member of the Department of Pulmonary, Allergy and Critical Care Medicine at Cleveland Clinic’s Respiratory Institute.

“The hypothesis is that sepsis patients are sicker when they get readmitted to the hospital. They require ICU-level care and may have multi-organ involvement compared with patients with AMI, heart failure, COPD, and pneumonia, which may lead to higher costs.”

Anticipating readmissions

For patients who had an index sepsis admission, 17.5% were readmitted within 30 days. Gadre and her research team identified predictors of sepsis readmissions.

  • Infection was the most common cause for 30-day readmissions, accounting for 42.16% readmitted patients.
  • Sepsis accounted for 22.86% of readmissions.

The other most common causes for sepsis readmissions were gastrointestinal (9.60%), cardiovascular (8.73%), pulmonary (7.82%), and renal (4.99%) conditions.

“Our findings serve to create awareness among clinicians, administrators and policy makers alike regarding patient populations that are vulnerable to sepsis readmission and thus increased utilization of resources. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this adverse outcome,” the research team wrote.

CMS Warns Detroit Hospital to Improve IC Issues or Lose Funding

The Centers for Medicare and Medicaid Services (CMS) has given Detroit Medical Center’s (DMC) Harper University Hospital until mid-April to correct its infection control problems or lose its federal funding, according to a story in The Detroit News.

The hospital was notified in January of the deadline to pass an inspection. Failure to do so could result in Harper losing the funding that provides 85% of its inpatient revenue, according to the story. The Michigan Department of Licensing and Regulatory Affairs conducted inspections in December on behalf of CMS after three cardiologists and a physician at DMC Heart Hospital claimed that they were terminated from management roles in retaliation for complaints they made about infection control issues. Heart Hospital shares many of Harper’s facilities and services. The inspection found flying insects in an intensive care unit, improperly attired surgical personnel, and problems with sterile processing of surgical instruments, the News reported.

Two of the cardiologists, Dr. Mahir Elder and Dr. Amir Kaki, filed a lawsuit this week in Detroit’s U.S. District Court, saying they were fired after complaining about dirty surgical instruments and other problems at DMC hospitals.

“Any suggestion that these leadership transitions were made for reasons other than violations of our Standards of Conduct is false,” DMC said in a statement released in response to the lawsuit.

Other DMC hospitals have come under recent scrutiny. Inspectors found that staff cuts at Detroit Receiving Hospital led to the discontinuation of surveillance of most surgical site infections. Meanwhile, Sinai-Grace Hospital, which also faces Medicare termination on August 31 if it doesn’t pass an inspection, was under threat of termination in 2018 because of building and nursing quality problems. Sinai-Grace recovered its deemed status in September but was inspected again in January after a November power outage left the hospital unable to treat a heart attack patient, who later died after being transferred to another hospital.

Check your State for deadlines on new hazardous waste pharmaceuticals rule

By A.J. Plunkett

Let your pharmacists and anyone else in your organization who handles hazardous waste pharmaceuticals know that flushing those drugs down a drain or toilet will be specifically prohibited as of August 2019. That is provided the EPA’s new final rule on the management of hazardous waste pharmaceuticals is published as planned on February 22 in the Federal Register.

The ban on sewering hazardous waste pharmaceuticals is “long overdue,” said Kristin Fitzgerald, with the EPA Office of Resource Conservation and Recovery on February 14 during the first of what could be several informational webinars the agency plans on the long-awaited rule.

Sewering “is a common practice in many healthcare facilities and it needs to stop,” said Fitzgerald, noting that the while the new prohibition applies only to hazardous waste drugs and only to those organizations covered under the new rule, the EPA strongly discourages the flushing of any pharmaceuticals by anyone anywhere.

While the final rule creating a new Subpart P to the federal Resource Conservation and Recovery Act (RCRA) does exempt controlled substances that are under the Drug Enforcement Administration’s jurisdiction from the new hazardous waste regulations, even those controlled drugs still are banned under the no-flushing rule. [more]

Hospital-Acquired Conditions drop 13%

By John Commins

Hospital-acquired conditions dropped 13% from 2014 to 2017; from 99 per 1,000 acute care discharges to 86 per 1,000, according to newly released federal data.

That reduction translates into 910,000 fewer HACs, including adverse drug events and healthcare-associated infections, which helped prevent 20,500 hospital deaths and saved $7.7 billion over the three-year span, according to a new analysis from the Agency for Healthcare Research and Quality.

AHRQ’s review quantifies trends for several HACs, including adverse drug events, catheter-associated urinary tract infections, central-line associated bloodstream infections, Clostridioides difficile infections, pressure ulcers, and surgical site infections.

The report showed marked declines in several categories, such as adverse drug events, which dropped 28%, and C. diff. infections, which fell 37% from 2014 to 2017.

“The updated estimates are a testament to the successes we’ve seen in continuing to reduce hospital-acquired conditions,” AHRQ Director Gopal Khanna said.

It was not all good news, however. HACs involving pressure ulcers increased by 6%, and the number of surgical site infections didn’t budge over the three years.

“There’s no question that challenges still remain in addressing the problem of hospital-acquired conditions, such as pressure ulcers,” Khanna said. “But the gains highlighted today were made thanks to the persistent work of many stakeholders’ ongoing efforts to improve care for all patients.

The Centers for Medicare & Medicaid Services wants to reduce HACs by 20% between 2014 and 2019, which would result in 1.8 million fewer HACs over the five-year period, potentially saving 53,000 lives and saving $19.1 billion in hospital costs.

CMS Administrator Seema Verma said Tuesday that the work around reducing HACs is ongoing, as her agency develops new patient-centered measures that place outcomes over processes.

“While I am so proud of this accomplishment, we are working to get to a smaller set of dynamic measures that patients can use to identify high-value providers,” Verma told the CMS Quality Conference.

Why Auditing Catheter Dislodgement is a Patient Safety Must

By Christopher Cheney

Dislodgement of venous access devices such as catheters is widespread and underreported, a survey of 1,500 clinicians shows.

There are several negative impacts from dislodgement of peripheral and central catheters including interrupted treatment, supply waste with catheter replacement, phlebitis, and infection.

Dislodgement is a significant source of wasteful spending at health systems and hospitals, the author of the survey, Nancy Morneau, RN, PhD, of Hartwell Georgia-based PICC Excellence Inc., told HealthLeaders last week.

“Accidental dislodgement may be a much bigger problem than central line associated blood stream infections. It contributes to the increasing cost of healthcare. When we look at the estimates of dislodged catheters, there are more than five million incidents. If you put dollars and cents to that, it’s more than a billion dollars that is lost every year,” she said.

The survey found high rates of catheter dislodgement.

 

  • 68% of clinicians surveyed said accidental dislodgement occurred often, daily, or multiple times daily
  • 96% said peripheral intravenous catheters were the most commonly dislodged vascular access device
  • The top three reasons for dislodgement were confused patient (80%), patients removing catheters (74%), and loose IV catheter tape or securement (65%)

Audits essential step

Auditing incidences of catheter dislodgement and other vascular access device failures is crucial to managing care, Morneau said.

“With value-based purchasing and pay-for-performance, everyone is on alert to reduce complications with these devices whether they are peripheral or central. By auditing complications—specifically dislodgement—we can identify causes and incidents. Then you can look to the solutions.”

Documentation is a key element of auditing.

The electronic medical record should account for discontinuation of vascular access devices for a patient including dislodgement, Morneau said.

“The EMR should have appropriate choices that include dislodgement and whether it was associated with securement, the dressing, or a patient dislodgement or a staff dislodgement. Looking at the reasons helps us to reach what the solutions may be.”

Health systems and hospitals also should encourage reporting of catheter dislodgements, she said.

“Hospitals can stress compliance with documentation and work on electronic medical record documentation in order to provide clear choices that are consistent with the reasons for catheter failure with dislodgement. Making a more accurate notation is one of the best ways hospitals can move forward with managing dislodgement.”

Auditing is foundational to improving vascular access device care, Morneau said. “Audit can help you achieve two key results: increasing education and helping to recognize where there are safety issues.”

CMS Report: AOs missing fire safety and IC deficiencies during survey

Expect CMS to continue pressuring The Joint Commission (TJC) and other accrediting organizations (AO) to find more of the serious life safety, environment of care, and infection control issues the federal agency says they are still missing during surveys.

In the newest report to Congress assessing AO performance, CMS says the overall disparity rate between serious problems identified by the AOs at hospitals and those found by CMS surveyors within 60 days of survey was 46% in fiscal year 2016, up from 38% and 39%, respectively, in the two preceding fiscal years.

Most of those disparities were in infection control and physical environment, says the report. CMS is particularly concerned that AOs are missing key Life Safety Code® (LSC) deficiencies, with fire and smoke barriers, sprinkler systems, electrical systems, hazardous areas, and means of egress taking the top five categories for missed problems in fire safety at hospitals.

Hospitals already face funding challenges to meet fire code requirements after CMS finally adopted the 2012 LSC, and it will get even worse as survey scrutiny increases, predicts Ernest E. Allen, a former TJC surveyor and current consultant and patient safety executive with The Doctor’s Company in Columbus, Ohio.

This is on top of TJC’s response to criticism in the report released last year. TJC began pushing its own surveyors to cite every life safety deficiency, no matter how small, Allen says.

More on this topic can be found on

Hospitals Can Improve Their Infection Prevention Strategies, Study Finds

By Jay Kumar

A new review of 144 studies found that healthcare-associated infections (HAI) can be reduced by as much as 55% through the implementation of evidence-based infection prevention and control strategies. Published in the Society for Healthcare Epidemiology of America’s (SHEA) journal Infection Control & Hospital Epidemiology, the study points out that hospitals can do much more to reduce infections.

“Healthcare-associated infections come at a considerable expense to patients and families, but also cost the U.S. healthcare system an estimated $9.8 billion each year,” said Keith Kaye, MD, MPH, president of SHEA, in a release. “There have been tremendous advancements in developing strategies to prevent and control HAIs. This study demonstrates a need to remain vigilant in identifying and maintaining key infection control processes to ensure they can be optimally used to prevent infections, which in some cases are life-threatening.”

The review was conducted by researchers from University Hospital Zurich and Swissnoso, the Swiss National Center for Infection Control, who examined 144 studies published worldwide (including 56 done in the U.S.) between 2005 and 2016 to determine the proportion of HAIs prevented through infection control interventions in different economic settings. The papers reviewed studied efforts designed to prevent at least one of the five most common HAIs using a combination of two or more interventions, including education and surveillance or preoperative skin decolonization and preoperative changes in the skin disinfection protocol.

The interventions produced a 35% to 55% reduction in new infections, the researchers found. The largest effect was for prevention of central line-associated bloodstream infections; other infections studied included catheter-associated urinary tract infections, surgical site infections, ventilator-associated pneumonia, and healthcare-associated pneumonia.

The study’s lead author, Peter W. Schreiber, MD, a researcher from the Division of Infectious Diseases and Hospital Epidemiology at the University Hospital of Zurich, said the review’s results show that hospitals are not doing enough to fight infections. “Our analysis shows that even in high-income countries and in institutions that supposedly have implemented the standard-of-care infection prevention and control measures, improvements may still be possible,” he noted. “Healthcare institutions have a responsibility to improve quality of patient care and reduce infection rates by effectively implementing customized multifaceted strategies and improv[ing] patient outcomes.”

Last Flu Season Led to 80,000 Deaths

Federal public health officials are urging everyone six months and older to get vaccinated against influenza in the wake of last winter’s severe flu season, which resulted in a record high of 900,000 hospitalizations and more than 80,000 deaths.

“Last season illustrated what every public health official knows—influenza can be serious in people of all ages, even in the healthiest children and adults,” said U.S. Surgeon General Jerome M. Adams, MD, MPH, at a news conference Thursday. “It is critical that we focus national attention on the importance of influenza vaccination to protect as many people as possible every season.”

The press conference was held to highlight what officials see as disappointing flu vaccination coverage estimates in recent years. Over the last several flu seasons, coverage among children aged six months to 17 years has remained steady but fallen short of national public health goals, which are 80%. During the 2017-2018 season, coverage dropped by 1.1 percentage points overall, with young children aged six months to four years with a decline in vaccination coverage of 2.2 percentage points. Even with the drop, vaccination coverage was highest in this age group (67.8%) and lowest among children aged 13 to 17 years (47.4%).

The CDC estimates that 78.4% of healthcare personnel were vaccinated during the 2017-2018 season, up 15% since the 2010-2011 season. Vaccination coverage was highest (91.9%) among healthcare workers in hospital settings and lowest (67.4%) among those working in long-term care settings. The CDC’s FluVaxView site has a more in-depth breakdown of these statistics.

Joint Commission Revises Scoring for IC Standard

The Joint Commission (TJC) announced scoring changes for its IC.02.02.01 standard, which requires facilities to reduce infection risk associated with medical equipment, devices, and supplies. The standard was included on TJC’s list of most-cited standards.

In the latest post in its 4-1-1 on Survey Enhancements series, TJC focused on high-level disinfection and sterilization. Effective as of September 1, the revisions are meant to hone in on the process steps that pose the highest risk to patients. TJC plans to monitor the revisions over the next several months to ensure scoring is consistent.

For example, IC.02.02.01 was previously scored on the finding of visible bioburden and dried blood of instruments. Now surveyors will cite hospitals if the wiping or flushing of soiled instruments isn’t observed during a case in the operating or procedure room and it’s clinically appropriate, or if an item that’s ready to be used on a patient is visibly soiled.

Standard findings recorded before September 1 will not be removed. Hospitals that are in the clarification window or preparing an Evidence of Standards Compliance report should document their compliance with the revised scoring guidelines.