The Value of Infection Control

Can Companies Help Bolster Value?

Copyright 2002,

Robert Garcia, BS, MMT(ASCP), CIC

IC Responsibilities

• Range: all depts.• Nosocomial infection

surveillance• Communicable

diseases• Employee health• Sterilization assurance• Medical devices

• Sanitation• Antisepsis• Engineering &

Construction• Patient Safety• Regulatory

requirements• Bio-terrorism planning

The IC Profession at a Crossroads

• 12,000 ICPs and dwindling• Responsibilities up 75% in acute care and

81% in LTC• Staffing has not changed for 60% of IC

departments or decreased nearly 25%• 75% over 45 years of age• Most nurses, but where are the nurses?

Jackson MM, Soule B, Tweetn SS. APIC Strategic Planning Member Survey, 1997. The Emerging Healthcare Delivery Systems Task Force. APIC. AJIC AM J Infec Control 1998;26:113-25.

Lack of Nurses and Infection

• >15 studies and reports equate decreased RN nursing staff with increasing nosocomial infections

• Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and quality of care in hospitals. N Eng J Med 2002;346:1715-22

• Jackson M, Chiarello L, Gaynes R, et al. Nurse staffing and health care –associated infections: Proceedings from a working group meeting. AJIC AM J Infec Control 2002;30:199-206.

Nosocomial Infections

• 4th leading cause of death in U.S.

• >$4 billion dollar cost to hospitals

• LTC, Ambulatory, others $ = unknown

• Resistant organisms

• IOM Report

• Media reports

ECONOMIC PRESSURE

HEALTHCARE INFLATION

MANAGED CARE

COST OF TECHNOLOGY

MEDICAID CUTS

Prophetic Insight on Future Paths

“…Because we do not provide direct care to patients, the value of our practice must be demonstrated in other ways. We must translate infection control activities into proposals and systems that gain priority by

stressing quality and economy.”

Pantelick EL. Hospital infection control: Dinosaur or Dynasty. Am J Infect Control 1989;17:56-61.

APIC Research Foundation Priorities Project

• A review of the world’s literature on IC and ID over the last 20 years

• Identified 65 of most published authors

• 43 responded to survey

• #1 top priority: Cost-effectiveness/financial impact studies

Report from the Research Foundation, APIC Educational Conference & International Meeting, June 2000, Minneapolis, MN.

What is at Stake?

• For infection control professionals:– A necessary increase in institutional value

attained by sustained decease in infections and demonstration of cost reductions

• For Industry:– The confirmation that a proven and high quality

product does make a difference– Enhanced market position

An Emerging Methodology

Interventional Epidemiology

“…IE examines all functions from a global health care viewpoint; that is, it takes into consideration the potent changes outside of a healthcare organization and in response integrates this knowledge into the internal process systems of the facility.”

Garcia R, Barnard B, Kennedy V. The Fifth Evolutionary Era in Infection Control: Interventional Epidemiology. AJIC Am J Infect Control 2000;28:30-43

Communication Between Providers

People Procedures

VAP

PoliciesEquipment & Devices

VAP surveillance rounds (observational periods between IC and nurses)

Physicians

Nurses

Intubation/Extubation

Cleaning & maintenance of ventilator & components

Definition of VAP

Oral & Dental Care

Cleaning of ventilator & devices

Closed suction system, oral suction catheters, water, other suction devices, suction canisters/tubing

Mechanical ventilator (Heated humidifier or HME)

Tracheostomy devices

Closed suctioning

Use of H2 antagonists/sucralfate

Handwashing

Filters

Pharmacists

Intubation/Extubation

Analysis of System Components Influencing the Occurrence of Ventilator-Associated Pneumonia

Nutritional Specialists

Nasogastric tubes

Placement & maintenance of nasogastric tube

Respiratory Therapists

Handwashing

Suctioning (closed/oral)

Oral Care

Vent circuits, filters

NebulizersMultidose vials

LaryngoscopesResuscitation bags

Barrier equipment

Ventilator circuitsTracheostomy care

Cleaning of laryngoscopes Nebulizers

Suction canisters Resuscitation bags

Placement and care of nasogastric tubes

Enteral feeding Weaning

Self-extubationSemi-recumbent positioning

Relay surveillance data to healthcare providers

Feedback from healthcare providers

The Practice Arena of Interventional Epidemiologists

Clinical Financial

Customer

Satisfaction

Can Companies Help Bolster IC Value?

• Provide a fresh perspective on infection transmission

• Provide economic and clinical rationale

• Provide viable interventional methodologies

• Provide effective education

• Provide support for the span of the partnership