Collecting and reporting hospital infection data to federal health agencies takes more than five hours each day, at the expense of time needed to ensure that frontline healthcare personnel are adhering to basic infection prevention practices such as hand hygiene, according to research presented recently in Nashville at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
Many infection preventionists (IPs), especially those in community hospitals, face the daily burden of state and federal reporting, particularly to comply with the CMS requirements.
Sharon L. Parrillo, BSN, RN, CIC, an IP at Robert Wood Johnson University Hospital Somerset in Somerville, NJ, decided to tabulate the time required to review lab data and complete reports for bloodstream infections, urinary tract infections, surgical site infections, MRSA infections, and Clostridium difficile infections to the CDC’s National Healthcare Safety Network (NHSN). IPs at hospitals across the country are responsible for analyzing lab reports and reporting infection data to the NHSN database, which is used for Medicare payment determination by CMS.
“HAI reporting exposes problems, drives improvements, and allows for benchmarking against national targets. But without adequate staffing, the burden of reporting takes time away from infection prevention activities that protect patients at the bedside,” Parrillo said. “We are fortunate that we have two IPs on staff at our hospital, but many community hospitals have only one staff person dedicated to infection control. This analysis didn’t even take into account the time necessary to perform state and local HAI reporting, which many facilities are also required to do.”
Parrillo calculated the number of laboratory test reports — urine, blood, wound, and sputum — received and reviewed in July, August, and December 2013 and January 2014 at her 355-bed acute care community hospital. Using NHSN time estimates for each infection event report, she calculated the total amount of time needed to review the lab reports and complete reporting using the NHSN criteria and definitions. This totaled 118.29 hours each month — or five hours and eight minutes per day, based on a five-day work week. It is also worth noting that during the time period assessed, the hospital was only at 60% capacity.
“I hope this study encourages lawmakers to consider the burden of IP time when new HAI reporting legislation is being considered, and helps IPs at other facilities start a conversation with their leadership about staffing and resources needed to ensure a safe environment for patients and staff,” she said. “Much of what I do involves sitting at a desk. It’s frustrating, because that’s not how I can prevent infections. We need to be able to do more rounding, more hand hygiene observance, more preparedness, and more staff education.”
IP-led intervention teams have been shown to reduce HAIs. In addition to meeting reporting demands, IPs educate healthcare workers and patients about infectious diseases and how to limit their spread. Antibiotic stewardship has become a huge issue, and IPs also conduct rounds with clinical and environmental teams, share data with individual hospital units for improvement efforts, develop and review infection prevention and control policies and procedures, and develop infection control plans during facility renovation and construction. Then, usually beginning on a Friday afternoon, there’s an outbreak.