Healthcare associated infections on the rise
The strains that healthcare workers have felt over the past three years are adversely impacting patient outcomes, as the latest Hospital Safety Grades data from The Leapfrog Group points to significant increases in three common healthcare-associated infections (HAIs).
The advocacy group’s ongoing analysis of safety and quality data pointed to a 60% increase from early 2020 to early 2022 in central line-associated bloodstream infections, which occur when germs enter the bloodstream through a catheter typically placed in the neck, chest, or groin. Over the same period, hospitals saw a 19% jump in catheter-associated urinary tract infections and a 37% rise in Methicillin-resistant Staphylococcus aureus, a staph infection commonly spread through direct contact with open wounds or unwashed hands.
The Leapfrog Group President and CEO Leah Binder called the findings “alarming” and indicative of a need to “recommit to patient safety and build more resilience,” especially as resources previously devoted to treating COVID-19 can and should be deployed elsewhere.
The Leapfrog Group analysis is consistent with data from the Centers for Disease Control and Prevention, which showed “continued increases” in HAIs compared to pre-pandemic numbers. Worryingly, those pre-pandemic numbers were largely unchanged from 2010, according to an Office of Inspector General (OIG) report. “This lack of substantial improvement is particularly disappointing,” OIG wrote in STAT News.
CDC data shows that more than 3% of hospitalized patients have a HAI. Addressing these infections costs hospitals more than $28 billion each year, due largely to a longer length of stay. The Centers for Medicare & Medicaid Services have established a Hospital-Acquired Condition Reduction Program, which reduces Medicare payments to poor performers. Additionally, the CDC and the Agency for Healthcare Research and Quality (AHRQ) provide toolkits for preventing infections, noting the effectiveness of tasks such as decontaminating medical devices, cleaning surfaces, and ensuring quality of drinking water.
While such steps are important, they fail to address the larger challenge of determining which patients face the greatest risk of HAI and acting accordingly. Many organizations tend to conduct retrospective analysis and identify opportunities for improvement based on past incidents even though they have enough in-house data – clinical notes, lab and radiology reports, and so on – to make real-time analysis and prevention possible.
The stumbling block, as with most analytics, is how data is formatted. When data is in a structured format, as is the case with vital signs, microbiology test results, ventilator settings, and other well-defined metrics, automated surveillance is possible and may indicate the presence of certain infections. However, unstructured data sources such as imaging results or clinical symptoms are some of the most important indicators of a potential infection. Uncovering this information often requires time-consuming manual chart reviews by staff trained in infection control.
A two-pronged effort to improve documentation in structured electronic health record system fields and to adopt standardized data elements would allow for wider utilization of automated surveillance systems, especially among hospital networks where multiple standalone systems may be in place.
There’s an additional necessary step, though: Applying this data to change clinical behavior. That could involve using EHR alerts to reduce unnecessary procedures that may cause an infection, or it could mean analyzing real-time data during childbirths or surgeries to better respond to potential hazards. Here, organizations must be certain that data is both timely and reliable to increase the odds of clinical buy-in and executive approval at a time when budgets for digital transformation are tight.
Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.