New reports show that infection prevention efforts at healthcare organizations are resulting in huge declines in healthcare-acquired conditions.
Catheter-associated urinary tract infection rates among nursing home patients at more than 400 sites dropped by 54%, according to the Agency for Healthcare Research and Quality (AHRQ) and a May 2017 study.1
Also, in December 2016, the U.S. Department of Health and Human Services (HHS) released a report showing that 125,000 fewer patients died because of hospital-acquired conditions (HACs), saving $28 billion in healthcare costs between 2010 and 2015. There were 3 million fewer HACs during that period.
These outcomes highlight the importance of infection prevention projects at ASCs as well. Small ASCs find it challenging to designate an employee to be competent in infection prevention and quality. But this role is so important that they should find a way to make it happen.
For instance, an ASC might employ a nurse administrator who performs multiple roles, including wearing the infection preventionist hat. Or, the ASC could contract with an infection preventionist, who helps the site develop best practices and quality improvement strategies.
“I consult for 30 ASCs, and started, this year, with a doctor’s group of 14 physician offices and long-term care facilities,” says Donna Nucci, RN, MS, CIC, an infection preventionist at Yale New Haven Hospital in New Haven, CT.
One way Nucci manages so many sites’ infection prevention efforts is by holding webinars in which various centers are on a shared telephone meeting. Participants can discuss shared problems between the ASCs, and discuss possible solutions.
“We did a call a few weeks ago and had an ASC in Boston talking with New York and Massachusetts,” Nucci recalls. “They were talking about drug shortages, finding good staff, processing instruments, and what type of antibiotic to give patients preoperatively, interoperatively, and postoperatively.”
When people work in a silo, they can’t collaborate and find out what is normal at other sites, she adds.
ASCs in rural or smaller cities might consider sending staff to infection prevention conferences and/or webinars, as these are good ways for them to learn about common infections, risks, and the latest research, Nucci suggests.
“Once that person reads studies and goes to conferences, they can bring that knowledge back to drive change in their institutions,” she says.
Nucci also suggests ASCs follow these strategies in infection prevention:
1. Improve communication between ASC board and infectious disease liaison. “The number one strategy is to improve communication between the stakeholders for the medical board and designated subject experts, including an infectious disease liaison or quality control officer,” Nucci says.
“In a small center, one person might take on both roles and watch quality, falls, other quality measures, and be the infectious disease specialist,” she says. “If you receive Medicaid dollars, you are required to have someone in this role.”
Regardless of who oversees infection prevention efforts, the designated person must engage in regular, quarterly communication with the medical board. If no one leads this task, it could result in a noncompliance notice by Medicare during a survey.
“There needs to be consistent, regular, and formal quarterly reporting between the infectious disease preventionist liaison and the medical board,” she says. “And this report should be in the meeting minutes, detailing specific things the liaison has surveyed in the institution.”
2. Keep track of staff flu vaccination rates. ASCs are required to report their employee flu vaccination compliance rate, and they could have trouble if the rate is low.
For example, if there is a 50% flu vaccine rate, and a patient undergoes surgery and then gets the flu, this would be a reportable problem, Nucci says.
All surgery centers must report employee vaccination compliance rates to the National Healthcare Safety Network of the CDC. This is for CMS’ ASC Quality Reporting Program requirements.
3. Create a comprehensive risk assessment with an annual report of mission and goals. This assessment should include risks that are particular to an ASC’s geographic area, including a focus on antimicrobial resistance strains that have been identified in area hospitals.
Even a region’s weather conditions could be included in the risk assessment. For example, in southern humid climates, ambulatory surgery patients might be at a greater risk of infections, particularly if they return to a home that doesn’t have air conditioning, Nucci says.
“Humidity and heat could be a factor in their healing and should be part of the risk assessment,” she says. “Also include the age of your patient population.”
The infection prevention program needs well-defined goals with a mission in place. When these are reported annually, there should be a comprehensive report.
ASCs could use an Excel spreadsheet with various tabs, including one for risks.
After a risk assessment, ASCs can identify infection prevention areas that need more attention, including hand hygiene and surgical instrument cleaning updates for staff. The infection preventionists could perform a hand hygiene observation study or ensure employees assigned surgical instrument cleaning are certified in sterile processing.
- Mody L, Greene MT, Meddings J, et al. A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA 2017 May 19. doi: 10.1001/jamainternmed.2017.1689. [Epub ahead of print].