The fight is on to bring HAIs to zero

Some challenges in healthcare have never been conquered, regardless of how much we try. A prime example is healthcare-associated infections, or HAIs, which account for an estimated 1.7 million infections and 99,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC).

William Sistrunk, M.D.

Every day, one in 31 hospitalized patients contracts at least one infection associated with hospital care—one person too many, according to William Sistrunk, M.D., an infectious disease specialist at Mercy Health in St. Louis and a HealthTrust Physician Advisor. While dramatic progress has been made in reducing HAIs over recent years—and this continues despite pandemic-related obstacles—aiming for zero HAIs is always the goal.

“We have to be on our A-game all the time, providing the best care to every patient every day to prevent HAIs,” says Dr. Sistrunk, whose 2022 presentation at HealthTrust University focused on this topic. “And we always have new providers and new ways of preventing HAIs, so you need to reteach and remind people. It’s a continuous project.”

Ripple effects

HAIs comprise several different types, including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI), C. difficile and methicillin-resistant Staphylococcus aureus bacteremia (MRSA). While all are dangerous, nearly one-quarter of HAIs nationally are SSIs, the top cause of postoperative deaths.

Kathleen McMullen, MPH, CIC, FAPIC

“Obviously, patients are the ones suffering immediate harm and effects from HAIs, but I’ve also seen multiple examples of coworkers who suffer detrimental effects,” says Kathleen McMullen, MPH, CIC, FAPIC, Director of Infection Prevention at Mercy Quality and Safety Center in Chesterfield, Missouri. “These effects include worry, concern and guilt over the potential that their care could lead to patient harm.”

Indeed, the ripple effects of HAIs extend to clinicians, health systems, insurers and society at large, Dr. Sistrunk says. The toll is incalculable: In addition to deaths, infections can lead to medical complications, extended hospital stays, loss of productivity, longer courses of antibiotic therapy, higher healthcare costs and drug-resistant organisms, among other implications.

“Now we also have many national organizations and insurers grading our care, so it’s even more transparent than just word of mouth,” he says. “If you have a good reputation for providing great care, you may find it easier to get people to work for you. It’s a reflection on the culture of your organization and your leadership, as well as your attention to detail and to patients.”

Tackling the problem

Bringing HAIs to zero is possible when hospital personnel know the protocols to avoid infection and follow them precisely every time, Dr. Sistrunk says. No other benchmark makes sense when considering something that can cost people their lives. “You run a real risk of your metrics sliding if you take your eye off continuous improvement,” he adds. “I think that’s what our patients expect of us.”

What are some best practices healthcare organizations need to embrace to eradicate HAIs? McMullen and Dr. Sistrunk offer these examples:

  • Follow published CDC guidelines to prevent HAIs, which include different “bundles” of information relevant to each type of HAI.
  • Practice rigorous hand hygiene before and after each patient encounter in every unit of a hospital and clinic.
  • Practice smart personal protective equipment (PPE) use.

“This means safely wearing PPE and knowing the level and amount of PPE required for the different processes healthcare workers need to perform,” McMullen further explains. “It’s not the same, for instance, for peripheral and central line insertion.”

Best practice alerts (BPAs), which transmit crucial information electronically about patient factors such as infection history, antibiotic use and symptoms, also support HAI prevention. They can continually alert clinicians to changes in patient status that may add up to larger infection risks.

“Make sure your BPAs are working and providing value,” Dr. Sistrunk says. “Ensure they’re not too intrusive and that whomever gets a BPA has the best data in front of them to respond well.”

Making an impact

HealthTrust helps promote HAI prevention through various efforts, McMullen and Dr. Sistrunk say. These efforts include “making it easy for health systems to order kits with all the pieces and sterile drapes needed to put in a central line safely,” Dr. Sistrunk adds. “We didn’t have that in the past.”

Going forward, connecting health systems to share HAI prevention best practices and standardize effective approaches could broaden HealthTrust’s impact. “We hear a lot of, ‘This worked for us,’ but it’s never as simple as it sounds,” McMullen says. “Facilitating more interaction between facilities—those successful and those struggling—can streamline this process.”

To discuss HAI prevention best practices, join the HealthTrust Huddle online community.

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