Joint Commission chief: No jump in IP 'problems'
Joint Commission chief: No jump in IP 'problems'
Fed bill: Report number of certified IPs
Asked about budget woes and cutbacks widely reported by infection preventionists, the president of the Joint Commission said surveyors are not seeing "any substantial increase in problems due to reduced staffing in these critical programs."
At a press conference, announcing a new Joint Commission initiative to reduce health care associated infections by focusing on hand washing improvement, Mark R. Chassin, MD, MPP, MPH, was asked about the job woes being reported by IPs.
"The Joint Commission standards and national patient safety goals — in other words, requirements for health care organizations that underpin safety and quality — don't change with economic fluctuations," he told Hospital Infection Control & Prevention. "If we find that there is a problem with infection prevention and control, we will work with the organization to solve it whether it is a staffing problem, a training problem, or an implementation problem. We are not seeing in our own survey results any substantial increase in problems due to reduced staffing in these critical programs. But our surveyors look for that, as well as lack of compliance with requirements for other reasons."
In findings that dramatically undercut the growing perception that infection prevention has become a top priority for the health care system, many IPs reported having budgets slashed and critical functions such as surveillance cut, the Association for Professionals in Infection Control and Epidemiology (APIC) reported recently in Fort Lauderdale, FL, at the group's annual conference.
The online survey was conducted March 20-27, 2009, netting 1,943 responses out of some 12,000 APIC members. Overall, 41% of respondents reported cuts in budgets for infection prevention in the last 18 months. Nearly 40% reported layoffs or reduced hours, and a third experienced hiring freezes. A proposed requirement for health care settings to publicly report their number of certified IPs is one of the main reasons APIC and other national infectious disease groups are strongly in favor of HR 3200, the America's Affordable Health Choices Act.
"That promotes the expertise and the value of infection prevention. It also promotes certification," says Christine J. Nutty, RN, MSN, CIC, president of APIC. "No facility is going to want its name and [infection] rates [posted] with zero CICs. It will raise the expertise level and that will help everyone. It will save lives."
The traditional staffing formula was one IP per 250 beds, but the current thinking with expanded job responsibilities is that there should ideally be one IP per 100 beds. "The public — and more importantly, the media — will be able to look at these numbers and [infection] rates," she adds. "It will help create pressure to get these facilities up to a minimum standard. I have a dear friend — I'd rather not say where she works — but she is in a 500-bed facility that does open heart surgery and any number of high-risk procedures. She is the only one; she is by herself."
APIC and other infectious disease groups see the HR 3200 as legislation that will secure program resources through requirements for accountability and transparency. As introduced in the U.S. House of Representatives, the health care reform bill would require hospitals and ambulatory surgical centers to report HAI data through an existing national reporting network managed by the Centers for Disease Control and Prevention as a condition of participation in Medicare and Medicaid. By mandating reporting via CDC's National Healthcare Safety Network, the bill will build on existing mechanisms and create a robust system to monitor, study, and ultimately prevent HAIs, according to a joint letter to Congress submitted by APIC, the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Council of State and Territorial Epidemiologists and the Trust for America's Health.
HAIs claim some 100,000 lives annually and incur more than $20 billion in excess health care costs. Indeed, President Obama specifically cited hospital infection prevention as one of the targets to wring out excess health care costs in a recent speech before Congress. The infectious disease groups agreed that the public reporting provision found in HR 3200 is superior to approaches that have been put forth in other legislation.
"Using CDC's network means that everyone will be looking for the same information in the same way," says Mark E. Rupp, MD, president of SHEA. "This approach for HAI reporting will be a more accurate way to compare local and national infection rates and trends. This will give us the science base we need to better prevent HAIs."
The bill does not list which specific infections would be reported, presumably leaving that to the CDC. The most ambitious section of the bill is the inclusion of ambulatory surgery centers, which typically have little infection prevention oversight and reporting regulations. However, perceptions are changing in the wake of many highly publicized outpatient hepatitis outbreaks, and that portion of the bill may actually give it more political traction.
"It's going to be very hard because the patients receive the care [in outpatient settings] and then they go on to different types of facilities or a hospital if they have complications," Nutty says. "There is not a good mechanism for letting those ambulatory surgical centers even understand that they had an infection. It is a major problem."
One element missing from the bill, the organizations noted, was the lack of a much-needed, strengthened federal approach to deal with antimicrobial resistant organisms.
"Overall, we applaud the approach taken on public reporting," says Anne Gershon, MD, FIDSA, president of IDSA. "However, we hope congressional leaders also will adopt new strategies to address drug-resistant pathogens, which are the cause of so many debilitating infections and patient deaths in health care facilities each year."
To address antimicrobial-resistant organisms, the groups have urged Congress to amend HR 3200 to include the Strategies to Address Antimicrobial Resistance (STAAR) Act, H.R. 2400, introduced earlier this year by Rep. Jim Matheson (R-UT), which will build up federal efforts on surveillance, research, and prevention and control of drug resistance.Asked about budget woes and cutbacks widely reported by infection preventionists, the president of the Joint Commission said surveyors are not seeing "any substantial increase in problems due to reduced staffing in these critical programs."
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