An Infection Control Playbook

Jay Moore, for HealthLeaders Media, October 16, 2008

Guidelines for reducing healthcare-associated infections are not hard to find. They're everywhere, in fact. But a new infection control compendium released last week is no ordinary guideline.

Myriad organizations have created specific recommendations for hand washing and inserting catheters and shaving the operative site and anything else you can think of (or might not want to think of, for that matter). Senior leaders are well aware of the numbers—roughly 2 million HAIs associated with nearly 100,000 deaths in U.S. hospitals every year, according to the Centers for Disease Control and Prevention—and have implemented all manner of prevention initiatives in an effort to reduce those figures. I have edited many stories for HealthLeaders magazine in which a hospital executive explains how his or her organization has made infection control a priority and is taking steps to make HAI prevention efforts part of the hospital's "culture."

The availability of recommendations isn't the problem—it's the adherence part of the equation that causes the trouble. Last year, a Leapfrog Group study found that 87% of hospitals don't consistently follow guidelines for preventing some of the most common HAIs. Only 35% of hospitals had full compliance with hand hygiene practices. A guideline is one thing, but following that guideline is quite another.

So when I first read about the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, the new HAI-prevention guidance released last week by The Joint Commission, the American Hospital Association, the Society for Healthcare Epidemiology of America, and the Infectious Diseases Society of America, I was skeptical. The new guidelines offer recommended practices for preventing methicillin-resistant Staphylococcus aureus, Clostridium difficile, central-line-associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, and surgical site infections. The compendium's authors don't claim that the guidelines are all that different from existing guidelines—they're just more concise and collected in a single source. So if the main problem with infection control has long been lack of adherence, not lack of recommendations, why should this latest attempt be any different?

The messengers, for one thing. The Joint Commission and the AHA uniting to create a singular infection control guidebook is quite different from a random organization offering its two cents on infection control. And by 2010, some of the new guidelines will show up in The Joint Commission's accrediting standards.

The format, for another. A consensus like this presented in relatively concise form should be much easier for healthcare workers to digest than the current volumes of infection control recommendations. Having a multitude of guidelines might seem like a good thing, but it's really not, says Robert A. Wise, MD, vice president of The Joint Commission's division of standards and survey methods. "One of the reasons hospitals are having difficulty now is that when they look at guidelines, they are drinking from a fire hose," Wise told The New York Times. "There are thousands of these things, and they don't quite know what to do with them."

So now we have a single playbook, backed by major organizations and organized in clear form, for preventing six of the most common HAIs. Practical advice on what to do and what not to do. No more excuses.

Will it work?

Personally, I think there's something to the theory that too much information from too many sources can cause paralysis. This compendium could genuinely help provider organizations take meaningful strides in the HAI fight. But infection control ultimately comes down to the individual. We've told you to wash your hands. You know the risks if you don't wash your hands. So wash your hands.

Will your people listen?

Jay Moore is managing editor for HealthLeaders magazine. He can be reached at
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