Waging a High-Tech Battle Against Hospital-Acquired Infections
Anne Dikon, director of infection prevention at Robert Wood Johnson University Hospital in Hamilton, goes online each morning to scan alerts of potential infections throughout the hospital. If the system flags a patient being readmitted, who previously had an infection, that patient will be assigned a private room. The system also highlights areas in the hospital with higher-than-average infection rates. That enables the staff to focus resources where needed to increase training on hygiene, hand washing, and cleaning.
Dikon is far from alone in her efforts. RWJU is one of 21 New Jersey hospitals participating in an initiative to reduce hospital-acquired infections (HAIs). The program recently reported that it has avoided about 14,000 HAIs in the six years through 2011, and saved its members approximately $51 million.
The collaboration among hospitals, Horizon Blue Cross Blue Shield of New Jersey, and the consulting firm CareFusion is increasing the speed at which medical centers can access and analyze their own infection data, allowing them to identify warning signs and take steps to keep patients from getting sick and infecting one another.
Years ago, hospitals would gather and analyze information after the fact and generate reports that were three months out of date. “We now have access to timely information, and that is helping us to be more detective-like,” Dikon said.
New Jersey is making progress on reducing HAIs, but there is room for improvement. That's the opinion of David Knowlton, president of the New Jersey Health Care Quality Institute.
According to the most recent New Jersey Hospital Performance Report, released last month by the Department of Health, the state's infection rates are a little better than the national average, “but we’re still seeing a lot of infections,” Knowlton said.
He noted that the March report showed that the state’s hospitals had 604 catheter-associated urinary tract infections in 2010, and 435 central-line associated bloodstream infections, which are contracted by patients on an IV.
“These are people who are suffering from infections, and who shouldn’t be,” Knowlton said.
Knowlton commented that the state Department of Health is a national leader in making individual hospital infections public. The March report, which is posted to the department’s website, reports four kinds of HAIs and next year will add two more.
Consumers can go to the health department website and read the report before checking into a hospital, but that rarely happens, Knowlton said. Instead. The real impact from public reporting of infection data is on the hospitals themselves.
“The hospital CEO reads this and says, ‘I have 24 infections compared to my competitor who only has one.’ And the hospital board reads this. And it changes behavior. Hospitals don’t like to be outliers: Transparency changes hospital behavior.”
One critical aspect of that transparency is discovering HAIs in the first place. Jim Albano, vice president of healthcare services for Horizon, said the company offers the CareFusion infection surveillance technology, known as MedMined, to the hospitals in its network. Some hospitals in the initiative have developed their own infection prevention programs or have partnered with other organizations like CareFusion. Regardless of the route the hospital takes, “what we try to do is get the message out that it is important for the hospital to engage in infection prevention," explains Albano.
Mark Spencer, vice president and general manager of MedMined Services at CareFusion, said the technology is an electronic surveillance tool that enables hospitals to track the location of patients and then use analytics to go in and find the root cause of infections. Infection prevention professionals then educate their nurses on best practices to avoid infection.
MedMined has a patented algorithm that looks at data from the hospital’s lab to detect infections early, said Spencer. “Then we do an analysis over time and look at patterns of where infections are occurring and look at patterns of care,” he said. “ A patient who comes into a hospital usually moves throughout the healthcare setting over time. Once that patient is identified with an infection, we track where that patient has been and then we look to find multiple patients with the bug.” That analysis may lead to a nursing unit with multiple infections.
The technology allows the hospital to move infection control “from a backroom counting that says ‘here is how many infections we have’ to proactively going out on the floors and better educating the clinicians,” Spencer said.
Said Albano, “Nobody wants to have a patient get an infection just because they happen to be in a hospital.”
Ev Liebman, state director for advocacy for AARP, said the Horizon results, “demonstrate that infections are preventable. When we prevent infections we save lives, so any progress in that area is important. At the end of the day, if you are the patient in the hospital and at risk for an infection that could kill you, you want to get as close as possible to no infections.”
And while public health is the first priority, the Horizon study also shows “it saves an incredible amount of money to prevent infections,” Liebman said. “I think you now are starting to see payers pay more attention to this because they know not only does it save lives, it saves money.”