Transcript The Value of Infection Control

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
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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
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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
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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
COST OF TECHNOLOGY
MEDICAID CUTS
MANAGED CARE
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
People
Communication
Between Providers
Procedures
Intubation/Extubation
Physicians
Analysis of System
Components Influencing
the Occurrence of
Ventilator-Associated
Pneumonia
VAP surveillance rounds
(observational periods
between IC and nurses)
Suctioning (closed/oral)
Nurses
Oral Care
Respiratory Therapists
Pharmacists
Relay surveillance
data to healthcare
providers
Cleaning & maintenance of
ventilator & components
Handwashing
Nutritional Specialists
Feedback from
healthcare providers
Placement &
maintenance of
nasogastric tube
Definition of VAP
Mechanical ventilator (Heated humidifier or HME)
Vent circuits, filters
Closed suction system, oral suction catheters, water,
other suction devices, suction canisters/tubing
Tracheostomy devices
Nasogastric tubes
Nebulizer
Multidose
s vials
Laryngoscopes
Resuscitation bags
Closed suctioning
Self-extubation
Semi-recumbent positioning
Handwashing
Oral & Dental Care
Use of H2
Cleaning of ventilator & devices
antagonists/sucralfate
Tracheostomy care
Ventilator circuits
Filters
Cleaning of laryngoscopes
Nebulizers
Suction canisters
Enteral feeding
Barrier equipment
Resuscitation bags
Weaning
Placement and care of nasogastric tubes
Equipment & Devices
Intubation/Extubation
Policies
VAP
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