The Journey to Zero

Innovative Strategies for Minimising Hospital-Acquired Infections

Topics: Infection Control, Quality, Clinical Operations, Safety, Workforce, Frontline Accountability, Strategic Alignment, Efficiency, Infectious Diseases, Surgery, Service Lines, Medical Errors, Mortality, Process Improvement, Care Coordination, Methodologies, Patient-Focused Care, Patient Satisfaction, Screening and Prevention, Access to Care, Appropriateness, Evidence-Based Practice, Outcomes, Clinical Research

With the country shining a magnifying glass on hospital performance, hospitals can little afford the damage that hospital-acquired infections (HAIs) cause with bad PR and insurance rates—hence, the emphasis on a zero tolerance policy for HAIs. After reading this publication, members will be able to reduce and possibly eliminate the incidence of HAIs by:

  • Assessing and elevating hygiene standards
  • Adhering to safe and sterile medical techniques
  • Minimising pathogen opportunity
  • Automating and integrating hospital IT systems

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Executive Summary

Rising Public Pressure

While infections themselves are certainly no newcomer to the quality agenda, unprecedented levels of scrutiny around performance have truly brought infection control to the forefront of hospitals’ patient safety goals in the recent months. News stories that highlight the devastating toll of infections are sweeping across the nation like wildfire. In response, an ever-increasing number of state and federal mandates have emerged to push the transparency agenda by holding institutions responsible for their performance.

With hospital-acquired infections featured prominently on the list of conditions selected for the "present on admission" provision of the Deficit Reduction Act of 2005, hospitals are faced with growing economic and regulatory pressures to develop sustainable solutions—particularly in light of data suggesting that Medicare patients are more heavily represented in the pool of infected patients than in the pool of non-infected patients. With industry data suggesting that infection is a result more of broken clinical processes than vulnerabilities attributable to specific patient populations, hospitals must develop innovative strategies to deal with the barrage of pathogens in their midst. In light of today's high-stakes environment, the consequences of failure are simply too high to absorb.

Failing to Deliver

Clinicians and administrators across the nation have wholeheartedly embraced the challenge of perfecting performance. While yesterday’s infections were considered an unavoidable consequence of delivering increasingly sophisticated care to an ageing patient population, today, infections are largely regarded as defects—and investigated accordingly. However, despite our collective promises, recently published performance data from the National Healthcare Safety Network (NHSN) suggest that, as an industry, we are falling far short of our goals. The staggering costs of these infections are steadily eroding the hospital bottom line—but more importantly, the associated morbidity and mortality present us with a clear imperative to develop sustainable solutions for elevating performance. In such a complex terrain, the opportunities for improvement—and emulation of top performers—are endless.

Identifying the Big Challenges

While each institution will face unique struggles in infection prevention, these challenges generally can be categorised into four larger themes that collectively drive suboptimal performance:

  • A lack of measurement that translates to poor understanding of internal infection burden, leaving priorities askew;
  • Poor dissemination of awareness to frontline staff, necessarily limiting the reach of any infection prevention initiative;
  • Minimal controls for variability in clinical processes, leaving room for human error and therefore increasing the potential for avoidable infections; and
  • A largely reactive strategy, resulting in short-lived initiatives that target infection flashpoints but fall short of achieving long-term quality gains.

Without a program carefully constructed to navigate the above missteps, institutions will not likely deliver on their promises of zero hospital-acquired infections.

Charting a Forward Path

The Clinical Operations Board herein presents three prerequisites and nine best practices for navigating the journey to zero preventable infections. This effort begins with an overview of the “state of the union” in infection prevention and control, a look at why infections have risen so rapidly to the top of the quality agenda. Next, three ideas to shape executive understanding and lay the groundwork for program (re)design, which we have designated as “prerequisites” before deploying resources in infection control.

We then move on to address the crux of the prevention question itself, with a focus on crafting a multipronged strategy. This begins with elevating frontline staff awareness. Next, we highlight tactics to minimise pathogen opportunities through process improvement across key patient populations, including a special report dedicated to a pathogen that is top-of-mind for many, methicillin-resistant Staphylococcus aureus (MRSA). Finally, we transition from elevating knowledge levels and improving execution of key processes to hardwiring long-term gains through leveraging data and creating a culture of accountability.