Healthcare Associated Infections: The Financial Implications

The subject of controlling HAI rates is a popular one recently.  Supporting data on the financial implications to assist healthcare institutions in proposing a plan of action is a bit harder to find. 

In a 2009 report titled “The Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Prevention”¹, the author uses the last comprehensive national research data from 1992 as a basis to estimate current expenditures due to HAI’s.

This report emphasizes the importance of distinguishing between “micro-costing”, or expenditures made by the institution for care, and the charges the institution extends to the patient. The report cites that HAI’s contribute somewhere between $28.4 to $33.8 billion dollars annual direct medical expense to US hospitals alone.  The author concludes “While there is still considerable variability in the costs of HAI, the cost estimates are substantial when compared to the cost of inpatient hospital stays for other conditions.”

Consider also that US hospitals are required to report certain types of HAI rates to the Joint Commission. High HAI rates, paired with poor results in the monitoring of programs such as hand hygiene, may lead to the revocation of Medicare payments. The possible impact of this type of finding is seen as one of the reasons US hospitals give serious credence to HAI preventive measures.

In early 2007, the APIC² published a brief entitled “Dispelling the Myths: The True Cost of Healthcare-Associated Infections”. This study aimed to inform the administrators of healthcare institutions about the cost of HAI’s by presenting a business case model. Citing an average cost of $5,018 to the net profit margin per infected patient, the brief goes on to suggest a step by step approach for any organization to begin implementing effective preventive measures.

Several cases were used to show how a zero tolerance approach³, focused on a particular area, can have a considerable ROI.

• It is recommended that the Infection Control Officer work with a partner in the Finance Department from the onset.
• A focused cost analysis can establish the baseline numbers.
• Using evidence based best practices (allocation of additional resources to ICP staff, evaluation of routine practices such as the frequency of changing out ventilator circuits, etc.) paired with monitoring and measurement of the results can lead to a dramatic reduction of the HAI rates.

One case showed how an investment of $35,000, targeted toward reducing specific HAI rates, captured a savings of $2.2 million in a two year period.

Beyond the financial numbers is the consideration of possible human lives saved.  This should remain an important topic with attention focused on advancements.  Adding to the published data and best practice reporting can benefit us all.

Healthcare Art Consulting, LLC seeks to contribute to a cleaner, safer healthcare environment by offering its Care & Maintenance with Infection Prevention + Control program.  Contact us for further information.

¹ R. Douglas Scott II, Economist

² Association for Professionals in Infection Control and Epidemiology, Inc.

³ Theoretical ideal of zero preventable infections

Origins of Infection Prevention Research; Florence Nightingale’s Influence

Today many medical practices look to experiential data from sources such as clinical trials, observational studies, outcomes research and case reports to improve and advance patient outcomes.  This methodology is often referred to as EBP or “Evidence Based Practice”.  While this concept employing scientific data collection and analysis makes a great deal of sense today, it is interesting to note that in its origins, the concept was novel.  Most historians credit Florence Nightingale as a pioneering force in its development.

Even at a young age, Florence had a keen interest in mathematics and its ability to solve questions and problems.  She was particularly drawn to making lists and organizing information.¹   She was educated in geography, history, languages and the social issues of the time.  Rare for a woman in 1827, Florence was fortunate to be part of a family with the means and the open mindset to provide this type of education.

Florence also showed a desire to help those less fortunate and was empathetic to those suffering from illness.  As she developed her own career in nursing, her knowledge, connections and financial backing gave her opportunities to become influential.  When asked to lead a nursing contingent at the Crimean War front, she began gathering data which would later be invaluable to her formulation of infection prevention practices.

She observed first-hand the overcrowded, unsanitary conditions and quickly established protocols for hygiene, increased medical and food supplies and routine scheduling of nursing activities.²  At the time, she was not sure what factors were contributing to the high mortality rates.  Later, upon her return to Britain, she began employing statistics and other analytics to derive valuable insights into her experiences.  Working with her data and experts of the day, she developed a series of coxcomb³ charts illustrating the number of deaths attributable to various causes and the high number related to unsanitary living conditions.  The germ theory of disease had not yet been adopted and this connection between hygiene and illness was not well known.  After her experiences with infection, contagion and epidemics, Miss Nightingale was challenging medicine with germ theory 17 years in advance of its being put forth by Louis Pasteur. 

Promoting military reform, she published her findings for military officials but also had them printed in pamphlet form to be distributed to influential politicians and the news media.  Throughout her life, her continued studies in healthcare advanced nursing practice and infection prevention knowledge.  The hallmarks of her working style, meticulous gathering of raw data and enlisting of the finest experts to help understand it and formulate solutions are at the basis of EBP.  

Nightingale used supporting evidence to transform healthcare. 

Healthcare Art Consulting promotes evidence based design practice and its mission to contribute to the credible pool of knowledge for today’s healthcare practitioners.

1- excerpt from Florence Nightingale: One Woman’s Vision, January 25, 2010, by Beth Vaughan Cole, PhD

2- Gillian Gill’s Nightingales: the Extraordinary Upbringing and Curious Life of Miss Florence Nightingale, 2004 states “ With an expert understanding of disease and possessed with the financial resources to allow her to take various measures, in the first four months…Florence Nightingale was the first person to institute a rational system for receiving and housing the patients as they arrived.  Appalled by the filthy, blood-and-waste soaked conditions the men arrived in, she made it a priority that the men and their linen should be washed and kept clean.

3-A coxcomb chart is a combination of a bar and a pie chart also commonly referred to as a “rose” chart.

Can healthcare facility maintenance go Green?

While “green” cleaning is being adopted in homes, schools and businesses in the US, the movement toward utilizing green cleaning practices in healthcare environments is occurring at a slower pace.  There are a myriad of reasons why this is and a lot of them are certainly justifiable.

Defining “green cleaning” with a set of standards that can be applied to healthcare is relatively new. In the past, green cleaning has often had a limited association focused on chemical cleaners alone.  Today, “Green cleaning in health care is about maintaining and improving cleanliness and supporting infection control while protecting workers and the environment from the risks posed by cleaning materials and processes.”¹

Late 2008 saw the roll out of the Green Guide for Healthcare.  These guidelines draw from best practices and cover topics ranging from environmentally preferred cleaning policies, products and equipment to sustainably sourced consumable materials.  This broader definition of green cleaning can serve as a template for organizations that are prepared to research, evaluate and implement new policies and procedures.

Concerns over patient health have been a driving factor in establishing effective guidelines.  Surgery suites and other areas in hospitals require sterilization with disinfectants.  There are several environmentally preferred disinfectants on the market today.  It is up to the individual facility to evaluate their comparative effectiveness.  Beyond the critical areas, there are also semi-critical and non-critical areas that can be addressed by different products and different cleaning methods to reach the desired efficacy.

Then there is the issue of added cost.  As one hospital administrator put it, “There are three criteria I use to evaluate proposals – cost, cost and cost.” With this in mind, many hospitals today are finding ways to move toward green cleaning programs.  Perhaps a phased approach needs to be considered.  As with everything, demand will continue to increase the offering of products with competitive pricing.  The larger picture of total cost vs. benefit is also important to consider.

Healthcare Art Consulting is currently evaluating a variety of green cleaning products for use in their Care & Maintenance plus Infection Prevention and Control program.  We’d love to hear about your successes.

¹From the training program “Green Cleaning in Today’s Healthcare Facilities” by O’Brien and Askin

Hospital staff at risk

In an environment centered on health, it may be surprising to learn that some employees are exposed to elements that can adversely impact their health. 

At major hospitals, the custodial staff is at high risk of work related illness due to repeated exposure to cleaning products, many of which contain chemicals associated with eye, skin, or respiratory irritation, or other human health issues. Additionally, the concentrated forms of some commercial cleaning products are classified as hazardous, creating potential handling, storage, and disposal issues for users.

Hazardous agents such as chlorine, phenol, carbitol, quaternary ammonium compounds and ethylene-based glycol ethers are common chemical ingredients in commercial and even in some home cleaning products.

A 2006 study sponsored by the EPA, and conducted by researchers at UC Berkeley, which focused on terpene and ethylene-based glycol ether containing products concluded that, while under ordinary circumstances exposure levels fall into the regulatory “safe” guidelines, the type of repeated exposure levels cleaning professionals experience tends to be twice the recommended levels.

The NORA¹ Services Sector Council is currently conducting a research study to collect data and ultimately publish “best practice” guidelines for building services workers in an effort to reduce the incidence and severity of occupational illness and injury.

Proper handling of any cleaning agent is an important first step in safety.  Manufacturers are required to label products clearly with proper dilution ratios and application guidelines.  Adequate ventilation during use of a cleaner or disinfectant and use of recommended “PPE” or personal protective equipment (protective gloves, eye-gear or masks) is also important. Once cleaning of an area is completed, the cleaning agents and tools should be removed, properly cleaned, stored and disposed of according to recommended guidelines.

The EPA promotes the implementation of EPP (Environmentally Preferred Products) cleaning products programs. Many of the recommendations in their guide² are based on the fundamental pollution prevention principles of reducing the quantity and hazards of materials in an effort to protect human health and the environment.

At Healthcare Art Consulting, our Care & Maintenance plus Infection Prevention and Control Program offers cleaning and long term maintenance of the artwork in healthcare environments. Our trained technicians employ “best practices and products” to achieve a high standard of cleanliness while protecting their health and the healthy indoor environment for hospital staff, visitors and patients.  Call and talk to us today about your facilities needs.

¹ National Occupational Research Agenda

² http://www.epa.gov/epp/pubs/cleaning.htm

A Look at Antimicrobial Coatings

Relatively new in the US market, a host of products utilizing antimicrobial nanotechnology are being introduced that, when applied to various surfaces, gives them the ability to kill disease causing organisms they come in contact with.  The question I hear the most in relation to this topic is “How long will the application last?”  Healthcare providers who make an investment in this science
want to know what to expect in terms of maintenance and longevity of these products. Understanding how these products work may shed some light on their potential long term performance.  Three of the more prevalent technologies are:

Embedded Silver Ions: Introduced at the nano-particle level on filaments in textiles such as cubicle curtain fabrics, these products act as an antimicrobial and odor prevention agent.  The silver particles attach to the microbes and essentially “short-circuit” them.  An issue of silver particles leaching over time with cleaning or deterioration has raised concerns due to  detrimental effects observed in the natural environment.

Brand names: Microban, Milgo

Organofunctional silanes: The active ingredient forms a passively charged polymer layer that molecularly bonds to the treated surface.  When a microorganism comes in contact with this layer, the active agent punctures the cell membrane and the electrical charge shocks the cell and kills it.  Application must be done on a clean surface and non caustic cleaners should be used to maintain the effectiveness of the coating over time.  This type of product effectively offers a “long term kill” with no breakdown of the active agent and no leaching.

Brand names: BIOSAFE^TM, Aegis “Microbe Shield”,  Triban

UV-PCO (Ultraviolet Photocatalytic Oxidation): This process exposes ultraviolet (UV) light to a catalyst such as (TiO2) titanium dioxide to produce hydroxyl radicals and super-oxide anions which then combine with surface elements and elements in the air such as bacteria and VOC’s.  There is an oxidizing effect which essentially “burns” the pollutant breaking it down into harmless carbon dioxide and water molecules.  Application must be done on a clean surface and some light must be present to trigger the reaction.  The catalyst which generates these results is never used up.

Brand names: Green Millenium, pureti™

How about longevity and ROI for this type of product?  Applied properly and maintained as directed, manufacturer’s state that these treatments can be effective over the life of the product or the surface that they are applied to.  Some offer a customized ROI analysis to help customers determine the best products and usage based on their facility’s unique needs.  Ultimately the cost savings are a complex calculation of savings in cleaning products, cleaning labor, insurance costs, liability costs, marketing benefits, and reduced absenteeism.

Healthcare Art Consulting’s Care & Maintenance + Infection Prevention and Control program offers an additional tool to the Facility Manager in their efforts to maintain a healthy environment for staff, patients and visitors.  We continually evaluate new technologies to provide “best practice” solutions in the maintenance of the facility’s investment in healing art.

Healthcare Art Consulting makes no claims related to the products named.