Survey: 68% of Hospitals Join in Infection-Control Efforts

Major Finding: Between 2005 and 2009, the proportion of hospitals that participate in a state or regional collaborative effort to reduce hospital-acquired infections jumped from 42% to 68%.

Data Source: Survey of 600 randomly selected U.S. hospitals.

Disclosures: Study was funded by the Department of Veterans Affairs, the National Institute of Nursing Research, and the Blue Cross/Blue Shield Foundation of Michigan. Dr. Krein stated that she had nothing to disclose.

ATLANTA — Between 2005 and 2009 there were significant increases in the use of some—but not all—recommended infection-prevention practices, according to survey results from 600 U.S. hospitals.

On Oct. 1, 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing U.S. hospitals for the additional cost of certain infections deemed to be preventable. At least 20% of all health care–associated infections (HAIs) are believed to be preventable, with estimates for specific types of infections ranging from 10% to 70%, Sarah L. Krein, Ph.D., said at the Decennial International Conference on Healthcare-Associated Infections.

“We're making progress, but effectively translating recommended infection-prevention practices into clinical settings remains a challenge,” said Dr. Krein, who is a registered nurse and a research associate professor at the University of Michigan, Ann Arbor, and the VA Ann Arbor Healthcare System.

The study sought to determine the impact of the CMS rule by surveying infection preventionists at 600 randomly selected U.S. hospitals with more than 50 beds in March 2005 and again in March 2009. The response rate was about 70% for both years.

From 2005 to 2009, the proportion of hospitals that have hospitalist physicians increased from 57% to 75%, and the proportion that participate in a state or regional collaborative effort to reduce HAIs jumped from 42% to 68%.

Respondents were asked how frequently a specific practice was used for hospitalized adults on a scale of 1–5. The practices were all included in recent recommendations by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control and Epidemiology. The analysis was weighted so that the results represent the population of U.S. hospitals from which the initial sample was selected.

In both years, practices aimed at reducing central line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) were implemented more often than those targeting catheter-associated urinary tract infection (CAUTI), even though the CMS nonpayment rule applies to CAUTI but not yet to VAP or CLABSI.

For CLABSI prevention, there were significant increases between 2005 and 2009 in those reporting “almost always” or “always” using maximum sterile barriers (71% to 90%), chlorhexidine as a site disinfectant (69% to 95%), and antimicrobial dressing (25% to 54%).

With regard to VAP, there were moderate increases in use of semirecumbent positioning (82% to 95%) and antimicrobial mouth rinse (41% to 58%), with a more dramatic increase in use of subglottic secretion drainage (21% to 42%).

For CAUTI, there were slight increases in use of bladder ultrasound (29% to 39%) and antimicrobial urinary catheters (30% to 45%) and a more dramatic increase in use of reminders/stop orders (9% to 20%).

Respondents were also asked for their perception of the effect of the CMS payment change on the importance of preventing the three types of infections. Those reporting a “moderate” or “large” increase in importance were 58% for CLABSI, 54% for VAP, and 65% for CAUTI, a finding that is “noteworthy, considering the data,” Dr. Krein commented.

She noted that CAUTI prevention practices in particular require both additional evidence to support their use and more effective strategies to facilitate their implementation.

CAUTI was not considered as high a priority by hospital staff, despite the fact that it is included in the CMS nonpayment rule while VAP and CLABSI are not, she said: “UTIs are still viewed as benign in many cases.”

Most practices were aimed at reducing central line infections and ventilator-asociated pneumonia.

Source DR. KREIN

Major Finding: Between 2005 and 2009, the proportion of hospitals that participate in a state or regional collaborative effort to reduce hospital-acquired infections jumped from 42% to 68%.

Data Source: Survey of 600 randomly selected U.S. hospitals.

Disclosures: Study was funded by the Department of Veterans Affairs, the National Institute of Nursing Research, and the Blue Cross/Blue Shield Foundation of Michigan. Dr. Krein stated that she had nothing to disclose.

ATLANTA — Between 2005 and 2009 there were significant increases in the use of some—but not all—recommended infection-prevention practices, according to survey results from 600 U.S. hospitals.

On Oct. 1, 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing U.S. hospitals for the additional cost of certain infections deemed to be preventable. At least 20% of all health care–associated infections (HAIs) are believed to be preventable, with estimates for specific types of infections ranging from 10% to 70%, Sarah L. Krein, Ph.D., said at the Decennial International Conference on Healthcare-Associated Infections.

“We're making progress, but effectively translating recommended infection-prevention practices into clinical settings remains a challenge,” said Dr. Krein, who is a registered nurse and a research associate professor at the University of Michigan, Ann Arbor, and the VA Ann Arbor Healthcare System.

The study sought to determine the impact of the CMS rule by surveying infection preventionists at 600 randomly selected U.S. hospitals with more than 50 beds in March 2005 and again in March 2009. The response rate was about 70% for both years.

From 2005 to 2009, the proportion of hospitals that have hospitalist physicians increased from 57% to 75%, and the proportion that participate in a state or regional collaborative effort to reduce HAIs jumped from 42% to 68%.

Respondents were asked how frequently a specific practice was used for hospitalized adults on a scale of 1–5. The practices were all included in recent recommendations by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control and Epidemiology. The analysis was weighted so that the results represent the population of U.S. hospitals from which the initial sample was selected.

In both years, practices aimed at reducing central line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) were implemented more often than those targeting catheter-associated urinary tract infection (CAUTI), even though the CMS nonpayment rule applies to CAUTI but not yet to VAP or CLABSI.

For CLABSI prevention, there were significant increases between 2005 and 2009 in those reporting “almost always” or “always” using maximum sterile barriers (71% to 90%), chlorhexidine as a site disinfectant (69% to 95%), and antimicrobial dressing (25% to 54%).

With regard to VAP, there were moderate increases in use of semirecumbent positioning (82% to 95%) and antimicrobial mouth rinse (41% to 58%), with a more dramatic increase in use of subglottic secretion drainage (21% to 42%).

For CAUTI, there were slight increases in use of bladder ultrasound (29% to 39%) and antimicrobial urinary catheters (30% to 45%) and a more dramatic increase in use of reminders/stop orders (9% to 20%).

Respondents were also asked for their perception of the effect of the CMS payment change on the importance of preventing the three types of infections. Those reporting a “moderate” or “large” increase in importance were 58% for CLABSI, 54% for VAP, and 65% for CAUTI, a finding that is “noteworthy, considering the data,” Dr. Krein commented.

She noted that CAUTI prevention practices in particular require both additional evidence to support their use and more effective strategies to facilitate their implementation.

CAUTI was not considered as high a priority by hospital staff, despite the fact that it is included in the CMS nonpayment rule while VAP and CLABSI are not, she said: “UTIs are still viewed as benign in many cases.”

Most practices were aimed at reducing central line infections and ventilator-asociated pneumonia.

Source DR. KREIN

Major Finding: Between 2005 and 2009, the proportion of hospitals that participate in a state or regional collaborative effort to reduce hospital-acquired infections jumped from 42% to 68%.

Data Source: Survey of 600 randomly selected U.S. hospitals.

Disclosures: Study was funded by the Department of Veterans Affairs, the National Institute of Nursing Research, and the Blue Cross/Blue Shield Foundation of Michigan. Dr. Krein stated that she had nothing to disclose.

ATLANTA — Between 2005 and 2009 there were significant increases in the use of some—but not all—recommended infection-prevention practices, according to survey results from 600 U.S. hospitals.

On Oct. 1, 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing U.S. hospitals for the additional cost of certain infections deemed to be preventable. At least 20% of all health care–associated infections (HAIs) are believed to be preventable, with estimates for specific types of infections ranging from 10% to 70%, Sarah L. Krein, Ph.D., said at the Decennial International Conference on Healthcare-Associated Infections.

“We're making progress, but effectively translating recommended infection-prevention practices into clinical settings remains a challenge,” said Dr. Krein, who is a registered nurse and a research associate professor at the University of Michigan, Ann Arbor, and the VA Ann Arbor Healthcare System.

The study sought to determine the impact of the CMS rule by surveying infection preventionists at 600 randomly selected U.S. hospitals with more than 50 beds in March 2005 and again in March 2009. The response rate was about 70% for both years.

From 2005 to 2009, the proportion of hospitals that have hospitalist physicians increased from 57% to 75%, and the proportion that participate in a state or regional collaborative effort to reduce HAIs jumped from 42% to 68%.

Respondents were asked how frequently a specific practice was used for hospitalized adults on a scale of 1–5. The practices were all included in recent recommendations by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control and Epidemiology. The analysis was weighted so that the results represent the population of U.S. hospitals from which the initial sample was selected.

In both years, practices aimed at reducing central line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) were implemented more often than those targeting catheter-associated urinary tract infection (CAUTI), even though the CMS nonpayment rule applies to CAUTI but not yet to VAP or CLABSI.

For CLABSI prevention, there were significant increases between 2005 and 2009 in those reporting “almost always” or “always” using maximum sterile barriers (71% to 90%), chlorhexidine as a site disinfectant (69% to 95%), and antimicrobial dressing (25% to 54%).

With regard to VAP, there were moderate increases in use of semirecumbent positioning (82% to 95%) and antimicrobial mouth rinse (41% to 58%), with a more dramatic increase in use of subglottic secretion drainage (21% to 42%).

For CAUTI, there were slight increases in use of bladder ultrasound (29% to 39%) and antimicrobial urinary catheters (30% to 45%) and a more dramatic increase in use of reminders/stop orders (9% to 20%).

Respondents were also asked for their perception of the effect of the CMS payment change on the importance of preventing the three types of infections. Those reporting a “moderate” or “large” increase in importance were 58% for CLABSI, 54% for VAP, and 65% for CAUTI, a finding that is “noteworthy, considering the data,” Dr. Krein commented.

She noted that CAUTI prevention practices in particular require both additional evidence to support their use and more effective strategies to facilitate their implementation.

CAUTI was not considered as high a priority by hospital staff, despite the fact that it is included in the CMS nonpayment rule while VAP and CLABSI are not, she said: “UTIs are still viewed as benign in many cases.”

Most practices were aimed at reducing central line infections and ventilator-asociated pneumonia.

Source DR. KREIN