Blueprint Needed for Infection Fight

John Commins, for HealthLeaders Media, October 6, 2008

Hospital human resources professionals across the nation are expected to play a role in determining effective staffing levels to identify and reduce healthcare-associated infections.

Good luck!

No one denies the seriousness of the problem. HAIs strike more than 2 million patients in U.S. hospitals each year and play a role in the deaths of nearly 90,000 patients—one death every six minutes—making HAIs the fifth-leading cause of death at acute-care hospitals, according to reports.

With that much at risk, you'd think there'd be a formula for determining whether or not your hospital is properly staffed for infection control. Something like: "X number of patients requires Y number of infection control staff." Nope. It's not that simple. There doesn't even appear to be a good rule of thumb out there anymore. CMS' longstanding "Study on the Efficacy of Nosocomial Infection Control," for example, recommends staffing at least one infection control specialist for every 250 occupied beds. But that report was published in 1980 and is widely considered to be dangerously obsolete.

At a one-day workshop held in August at Leiden University Medical Centre in the Netherlands, a panel of infection control experts agreed that one full-time infection control practitioner was needed for every 178 hospital beds. But the panel also questioned the validity of basing HAI staffing needs purely on the number of beds.

It gets worse. A new HAI study published this month in Healthcare Epidemiology reviews scores of previous HAI studies and determines that more HAI studies are needed. Ugh!

The report, Hospital Staffing and Health Care-associated Infections: A Systematic Review of the Literature, found that hundreds of previous HAI studies were either flawed, or were pretty much useless beyond a small set of comparisons. About the only thing the researchers could glean from the 42 studies it could accurately compare was a correlation between HAIs and levels of staffing, particularly of nurses, their level of training, and their familiarity with their particular environment. Thus, more, better-trained and permanent staff nurses appear to reduce HAIs. This is not news.

All this uncertainty about infection-control staffing levels comes as CMS this month begins a clamp down on reimbursements for HAIs, and as the media cranks out more and more stories about deadly "super bugs" and other hospital-borne health threats.

"It would be nice to say there is a magic bullet out there, just hire this many staff and your problem is solved, but that's not the case," say Gina Pugliese, vice president of Premier Safety Institute. "Maybe there shouldn't be a specific number of practitioners per bed unless it's really researched. You have to look at the acuity of the patients, and the numbers and types of units and the patient populations and their risk factors before you can decide what kind of infection-control staffing you need."

Until new research offers more-concrete staffing guidelines and other strategies, hospitals may well be on their own in the war against HAIs. In the meantime, the Association of Professionals in Infection Control and Epidemiology is suggesting a cultural change in the way hospital leadership addresses HAIs. APIC and Premier two weeks ago completed a survey of 930 infection preventionists nationwide, and only 15% of the respondents said their executive and physician leadership are actively engaged in fighting infections at their hospitals.

Given the scope of the problem, those survey results are staggering.

"Healthcare leaders must make infection prevention a priority and allocate resources to efforts that target institution-wide prevention, education, measurement and process improvements," says Kathy Warye, APIC's CEO.

Either that, or they can wait around for another study.

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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