Reporting skyrockets, will prevention follow?

'We need evidence-based policy making.'

Patricia StoneThe continuing state and federal mandates requiring hospitals to report healthcare associated infections threatens to outstrip their original justification, raising questions about whether the labor-intensive efforts will result in true reductions of HAIs, warned Patricia Stone, PhD, FAAN, professor of nursing and director of the Center for Health Policy at Columbia University in New York City.

"Are people getting less HAIs? We still don't know that because some people said they are just getting more careful at 'calling' that," Stone said recently in Baltimore at the annual conference of the Association for Professionals in Infection Control and Epidemiology. "Rigorous, long-term evaluation of these policies is needed to inform decision-makers. I don't think we truly know yet what is going on. It's clear we need evidence-based clinical processes because we need to know what works at the bedside, but we also need evidence-based policy making. We need to inform the policy makers whether these policies are appropriate or not."

The role of the infection preventionist is evolving, with the various forces of empowerment threatened by the growing data demands. On the one hand, IPs are reporting more time spent in their offices, as data collection and reporting requirements reduce their time on the floors and their interactions with staff, she noted. At the same time, the field has an elevated profile that offers unprecedented opportunity.

"Your role is not the same as it used to be, it's changing and it's likely to change more," she told APIC attendees. "This is giving you an increased visibility and I encourage people to embrace this. Get the leadership skills that are needed with this increased visibility because you might be reporting more to the C-Suite. You need to manage the staff at the bedside and learn how to educate them and get them to improve their compliance — and maybe be more of a coach and a leader."

Few states have been more inundated with infection rate reporting requirements than California, which recently added some 26 different surgical site infections to the list of other HAIs already required, she noted. "California hospitals are quite concerned right now with what's been legislated," Stone said.

While reporting some of her ongoing research findings and survey data for California, her general conclusions could easily apply to IPs in other states facing similar HAI reporting challenges.

"There are intended and unintended consequences," she said. "There is frustration. People are not able to address local issues. There are varied reporting requirements between state and federal policies. The IPs are spending more time on surveillance and less time on teaching and prevention."

In qualitative data based in part on interviews with IPs, a common theme is the need for "an organizational climate with shared accountability, teamwork and effective communication structures," Stone said. "This is what everybody said they needed if they were going to decrease HAIs."