CMS: 'Now that we have your attention.'

Funding cuts motivate some hospital leaders

While IPs would no doubt like to see even higher numbers, one effect of the Centers for Medicare and Medicaid Services 2008 reimbursement cuts is that more hospital senior administration and clinical leaders are preaching the gospel of infection prevention. Put less generously, the CMS action to shut off the cash flow for certain healthcare associated infections (HAIs) has had what certainly was one of the intended effects: A few spilled cups of coffee on the C-Suite desk.

Overall, 41% of IPs surveyed reported that their hospital executive leadership had spoken with frontline staff about infection prevention as a result of the CMS policy, said Grace Lee, MD, MPH, one of the research leaders of the unpublished study and an associate medical director of infection control at Children's Hospital in Boston.

Bringing HAI prevention to the attention of administration can only help IPs struggling for program support and resources. However, only 13% of IPs felt that they were the "primary driver" for their hospital to be a safety center institution, Lee said. "Some other [IPs] felt that they were 'somewhat of a driver,' but I thought that low number was interesting," Lee said.

The need for topline medical support has often been underscored through programs that include "physician champions" or "peer-to-peer" approaches to get physicians tuned in to infection prevention.

"In terms of hospital clinical leadership, a greater proportion — 67% — had spoken to frontline staff about infection prevention," she said. In addition, more than half of the infection preventionists felt that their frontline staff were receptive to changes in clinical processes.

Of course, that means the other half of that glass is dead empty, but another encouraging sign was that 62% of IP respondents said their frontline staff had "a sense of personal responsibility" for improving patient care and outcomes. There are limits. Only 3% said these workers felt "extremely empowered" to hold each other responsible for infection control practices. That, despite the fact that some of the most successful infection control interventions in recent years have stressed the importance of giving any health care team member the freedom to point out lapses in technique and protocol. Obviously, there is way to go in overcoming entrenched work cultures.

Not surprisingly, most hospitals facing the CMS policy changes followed the money, targeting more surveillance and education resources to the infections in jeopardy of non-reimbursement.

"In terms of the impact of the CMS policy on infection prevention, 81% of hospitals felt there was a greater focus on the HAIs targeted by the CMS policy — the UTIs, BSIs and these selective SSIs," she said. "However, nearly a third of the hospitals said there was actually less time to prevent HAIs that were not targeted by the CMS policy. So it was really a shifting of resources from their perspective."