Imagine being hospitalized for a routine surgery. Maybe you tore your ACL, or you needed a knee replacement, but otherwise you’re perfectly healthy. The surgery goes well, and you have every expectation of going home in a couple of days. However, instead you acquire an infection at the very place you go for healing — the hospital. It prolongs your stay, increases your costs, and can even be deadly. This example has become the harsh the reality for too many Minnesotans: Around 1 out of every 25 patients hospitalized are affected by a hospital-acquired infection (HAI).
Patients acquire these infections while receiving treatment for a medical condition in the hospital as the result of being exposed to a foreign bacteria, fungus or virus. There are a number of different manifestations of infections, but all HAIs are a problem. This risk of acquiring an infection is embedded within Minnesota’s hospital systems. The issues contributing to this problem are improper sanitation techniques, diseases being passed between patients and hospital workers and the overprescription of antibiotics.The National Healthcare Safety Network developed a measure to track HAIs: The standardized infection ratio (SIR) compares the actual number of infections at the hospital to the “predicted” number of infections, adjusting for several risk factors. According to Medicare’s Hospital Compare, among the six acute care hospitals within Hennepin County, the hospitals’ average SIR for three infection measures were worse than the national benchmark. In 2015, there were a total of 184 HAIs reported throughout the six hospitals; based on the average cost per infection, these totaled an estimated 2 million of direct hospital costs. Of these infections it would be expected that 10 would be fatal, although 70 percent of these infections are thought to be preventable using existing prevention practices. We can do more to prevent HAIs in Minnesota.
A firsthand experience
As an employee of the Hennepin County hospital system for four years, I have seen the repercussion of HAIs firsthand. The most memorable case was a patient who was healthy prior to a hip replacement and seemingly recovered well. The patient was discharged home only to return within 24 hours with a serious infection that led to kidney failure and the need for dialysis. This complication cost the family thousands of dollars in health care costs, but more importantly took a detrimental toll on the patient’s health and well-being.
In 2014 when the U.S. Centers for Medicare and Medicaid Services began requiring the reporting of HAIs and financially penalizing hospitals with the worst rates, hospitals gained motivation to slow the rates of infections. However, this policy led to penalizing physicians for HAIs and since Medicare is unable to directly monitor outcomes, it relies on accurate self-reporting of HAIs. This causes financial incentives for physicians to bias their claims to collect greater reimbursements resulting in underreported HAI rates.
Around the same time was the issue of hand washing compliance. Health care providers tend to clean their hands less than half of the times they should. This was observed through workers recording whether or not staff would wash their hands. However, this practice failed as it led to biases in reporting because employees would intervene to ensure compliance for their unit. Continued compliance is an issue as workers report the hand sanitizing foam dries out their hands and many have the perception that hand hygiene has little impact on patient outcomes.
While current Minnesota statutes support the reduction of HAIs, they remain a problem within the hospital systems because of a lack of prevention strategies and sanitation compliance. Although there are several possibilities to establish change with this problem, a necessary one is educating the population and health care workers on proper hand hygiene compliance. Policy-makers should promote programs such as the compliance monitoring system created by Minnesota’s Ecolab. This color-coded monitoring systems alerts patients and health care providers when they need to wash their hands again. Trial runs have shown a 40 percent increase in compliance rates.
Oversight and accountability of health care professionals must occur to decrease patient suffering and the expenses associated with hospital-acquired infections in Minnesota.
Casey Rieck is a University of Minnesota School of Public Health graduate student in the Division of Health Administration and Policy.
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