How risk managers and infection control and prevention teams can work together
By: Yves Crehore, Director of Clinical Surveillance and Peter Holt, Product Manager, Infection Surveillance
COVID-19 brings staggering increases in HAIs
Healthcare acquired infections (HAIs) are important and largely preventable complications occurring in healthcare settings, often leading to serious and negative health outcomes and economic burdens to patients, families and healthcare providers alike.
With the recent release of the “The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network,” we have concrete evidence showing the pandemic’s impact on HAIs. Central line-associated bloodstream infections have increased an average of 47%, catheter-associated urinary tract infections have increased 19% in ICUs and ventilator-associated events have increased 45% across all location types.
“The unfortunate reality is that in one year we lost nearly a decade of progress against HAIs like central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant Staphylococcus aureus (MRSA), and ventilator-associated events,” Ann Marie Pettis, BSN, RN, CIC, FAPIC, president of the Association for Professionals in Infection Control and Epidemiology (APIC), said in comment.
Increased HAIs have wide-reaching impacts on hospitals
These dramatic increases are devastating for patients and hospitals alike. As Goguen (2015) notes, “Because it’s so difficult to show exactly how the infection was transmitted — only that it occurred while in treatment — the hospital itself is the most likely to be held responsible… Determining liability for injuries or death resulting from HAI and sepsis can be very challenging from a legal perspective, and requires an investigation into the specific circumstances of how the infection was acquired, why it was not promptly treated, and whether it could or should have been prevented.” The impact of secondary infections expands beyond just patient outcomes and affects hospital operations, including financially and reputationally.
Approaching infection surveillance and risk management as a joint effort
Knowing the staggering impact increased HAIs can have on health systems only further emphasises how critical it is for Risk Management teams to leverage the expertise and knowledge of Infection Prevention and Control (IPAC) and Antimicrobial Stewardship teams to understand and mitigate HAIs in their care populations. Partnering through data gathering, analysis and interpretation, providing team leaders with evidence of potential threats and communicating resource placements across teams mitigates and intercedes in the blooming HAI crisis.
With the much-noted pressure on staffing throughout the hospital system, it is becoming increasingly important to reduce as much duplication in work and responsibilities as possible. Utilising a purpose built, software based, electronic infection surveillance tool as the primary source of infection data empowers IPAC to work collaboratively with Risk departments to break down silos and interpret information. With the right tools, risk managers don’t have the burden or overhead of relying on a clinically complex, nuanced and ever-changing set of (NHSN) definitions and instead can rely on a subset of verified data from a tailored infection system providing a 360-degree view of HAIs and risk factors (MDRO burden, HH rates, SSI and drug utilisation).
In order to successfully engage in cross-collaboration, hospitals must invest in trained personnel, thoughtfully implemented technological tools and specialised support. In times of COVID-19-related threat response and fiscal scarcity, these tools need to be lobbied for and their acquisition must be supported by staff and executive team members.
Collaboration between Risk Management and Infection Prevention & Control is a powerful lobbying voice during spending discussions
Clearly define your vision, goals and timelines together to approach discussions with a shared vision.
- Do you want to increase detection capacity?
- Better data management and security?
- Do you want to start prospective surveillance?
- Do you need early outbreak detection and outbreak management tools?
- Link your goals to the hospital’s priorities (financial, quality improvement and safety initiatives).
- What actionable data and/or insights can you bring with you?
- Identify an example story or patient journey that relates to the hospital’s priorities.
Make the case for a cross disciplinary need.
- Invite the pharmacy team (antimicrobial stewards), infection disease groups, intensivist and surgical physicians’ groups into the discussions, as this will impact them too. Remember; nothing about me without me. They can be strong voices and advocates for you.
- Identify champions within your organisation.
- Tune the message to the audience.
- Try to include something for each decision maker in your audience.
Consider using the resources below from recognised authorities to position your requests.
- Australian Commission on Safety and Quality in Healthcare – Standard 3 (AUS)
- ACSQH - HAI Fact Sheet (AUS)
- APIC calculator (US)
- CDC (US)
- Australian College for Infection Prevention and Control (AUS)
- Regional and Federal authorities which issue the mandates
Reducing the incidence of healthcare acquired infections and colonisations will influence an organisations’ average length of patient stays, and that alone will substantially reduce the patient risk of other HAIs. Ultimately, by controlling nosocomial infections in care populations, healthcare systems can provide a safer, more protected organisation by positively impacting both patient and staff safety.