ICPs should raise profile, show cost-cutting results

Not the time to be 'quietly effective out in a corner'

Infection control professionals working in today's managed care environment may stave off budget cuts and bolster the status of their programs by documenting and communicating efforts that save money and enhance quality, veteran ICPs advise.

While it may prove difficult at times to show the profit potential in prevention, the cost-saving power of effective infection control programs has been demonstrated in the medical literature.1 (See chart, below.) ICPs working under managed care systems, however, emphasize that now is not the time to assume management is well aware of your value and the efficacy of your program based on past studies.

"Visibility is extremely important," says Eddie Hedrick, BS, MT(ASCP), CIC, infection control manager at the University of Missouri Hospital and Clinics in Columbia. "When you are quietly effective out in a corner these days -- you're expendable."

While documenting any savings in areas like product purchasing and eliminating unnecessary infection control rituals, ICPs should communicate special program projects and emphasize interaction with other members of the clinical team. For example, a recent successful effort to lower bacteremia rates in an intensive care unit was followed by a special presentation of an infection control award to the ICU staff, Hedrick says.

"That recognizes them, but it also brings our department to the forefront," he says. "While it can be hard to measure a disease that is prevented, consider measuring your value to the hospital in other ways. I keep a little journal. Every time I have a phone call with a department and there is some cost-savings involved, I keep track of it."

While such efforts will vary by ICP and hospital, a good first step is a brainstorming session to document aspects of the current program that improve quality and save money, says Patrick Joseph, MD, CEO of California Infection Control Consultants in San Ramon. A specific intervention that can be measured baseline and afterwards can demonstrate efficacy, he notes. An example is reducing nosocomial pneumonia by reviewing and adopting infection control measures recommended in medical literature like the most recent Centers for Disease Control and Prevention guidelines on the subject.2

"Nosocomial pneumonia is a big ticket item," Joseph says. "One could document the baseline rate, develop a multidisciplinary team to identify high-risk patients, and institute appropriate methods to reduce the risk based on the available literature. Each case of nosocomial pneumonia costs the hospital between $5,000 to $20,000. [ICPs] may have always done the first part, but now it comes down to putting the financial figure on the value of their efforts. So now, if one reduces the incidence of nosocomial pneumonia by 10 cases per year, we're looking at a cost savings of $50,000 to $200,000 per year to the hospital."

Publicize successful effort

Document such efforts quarterly, if possible, and present them to the infection control committee or other appropriate forum, he adds.

"Presentation of documented success is mandatory," Joseph says. "No one will know how good we are unless we show them in a clear and concise way on a regular basis."

With regard to infection control rituals, there is increasing evidence both in CDC guidelines and independent studies that frequent changing of patient ventilator breathing circuits entails expense in labor and equipment that yields no reduction in nosocomial pneumonias. (See Hospital Infection Control, April 1994, pp. 45-49.) Indeed, while the CDC took the relatively conservative stance of recommending vent circuit changes no more often than every 48 hours, many ICPs are reporting thousands of dollars in savings without compromising quality by taking circuit changes out to seven days and beyond. In attempting such efforts, it is vital to work hand-in-hand with the respiratory therapy department that actually does the circuit changes, bringing them into the study to ensure the findings will result in real changes.

"The real skill is in changing behavior of health care personnel," Joseph says.

Another possible area to target for ICPs in hospitals that frequently admit suspected tuberculosis patients, is to weigh the benefit of purchasing more rapid test kits vs. the cost of prolonged isolation of patients who ultimately are found not to have TB. For example, Joseph found the practice of isolating patients who have positive acid-fast bacilli smears can result in many uninfected patients occupying isolation rooms. Reviewing the situation at one of his client hospitals, Joseph estimated an overall annual cost of $200,000 for unnecessary isolation. Rather than TB, about 75% of those under isolation were AIDS patients with non-tuberculosis mycobacteria, he found.

"They do not need isolation -- which includes the N95 TB masks, controlled ventilation, private rooms, therapy with four drugs, and all of the other costs that go along with it," he says. "There are some new lab tests on the market that cost $200 to run, but you get your answer in one day. We didn't consider those until we looked at the costs of keeping all of these people in isolation unnecessarily. Now we are in the process of bringing in that new lab test so that anybody with a positive smear will get the test, and if TB is excluded, isolation will not be necessary."

(Editor's note: ICPs who would like to present cost-saving projects and strategies to demonstrate program efficacy in upcoming issues of Hospital Infection Control should write Gary Evans, Editor, American Health Consultants, P.O. Box 740059, Atlanta, GA 30374. Please include a daytime telephone number.)

References

1. Haley RW. Managing Hospital Infection Control for Cost-Effectiveness: A Strategy for Reducing Infectious Complications. Chicago: American Hospital Publishing; 1986.

2. Centers for Disease Control and Prevention: Hospital Infection Control Practices Advisory Committee. Guideline for prevention of nosocomial pneumonia. Infect Control Hosp Epidemiol 1994; 15:587-627. *