Many hospitals cut back on infection-control efforts

Infection preventionists say budget cuts could hurt patients and cost hospitals money over time.

By Kevin B. O’Reilly — Posted June 22, 2009

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Hospital-associated infections annually kill an estimated 100,000 people and add $20 billion to the nation's health care bill. The increasing prevalence of multidrug-resistant organisms, state infection reporting mandates and the looming threat of an influenza A(H1N1) pandemic have made the job of preventing infections and controlling their spread that much harder.

But amid the worst recession in decades, hospitals are cutting back wherever they can, and infection-control professionals report that their departments are not being spared.

Four in 10 infection control professionals, who now prefer to be called "infection preventionists," said they have seen staffing or resource cuts in the last 18 months, according to survey results released in June by the Assn. for Professionals in Infection Control & Epidemiology Inc.

"We have made tremendous strides in infection prevention over the last few years," APIC CEO Kathy L. Warye said at a news conference. "Institutions are setting ambitious goals, and the evolving science will help us reach zero infections -- if not today, then certainly tomorrow. But to sustain that momentum, resources must continue to flow toward infection prevention. Many infection control departments are understaffed and underfinanced."

Of those infection preventionists experiencing a budget squeeze, three-quarters have seen funding for educational efforts take a hit. More than half said their budgets were reduced. Nearly 40% of the approximately 2,000 respondents said cutbacks have reduced their departments' ability to focus on infection prevention.

"We can't protect patients from hospital-acquired infections without adequate numbers of well-trained staff," said APIC President Christine J. Nutty, RN. "These cuts have made it harder for us to do the work that protects patients."

According to Consumers Union, 26 states have laws requiring some reporting of hospital infections. More than half of infection preventionists said these mandates have forced them to spend more time entering data and less time training health professionals and making rounds.

"One infection preventionist told us, quite candidly, that they had been in the office for 80% of time and not in the operating room in the last eight months," Nutty said.

Cuts criticized

It costs $300,000 to pay for two infection preventionists, one clerical staffer and a half-time medical director -- "peanuts when looking at the operating cost of a hospital," said Denise Murphy, RN, MPH, vice president of quality at Main Line Health in Pennsylvania. Avoiding fewer than 10 bloodstream infections could finance that infection control budget, she said.

Murphy said studies show that bloodstream infections cost hospitals an average $45,600 per case, ventilator-associated pneumonia cases cost about $10,000 and each instance of urinary-tract infection cuts profit by $1,000.

Lisa McGiffert, director of the Consumers Union's Safe Patient Project and Stop Hospital Infections campaigns, said the survey results show that hospitals are taking a "shortsighted view" of how to handle the recession.

"These cutbacks really do put more patients at risk," McGiffert said. "They reflect some serious management issues as to what are the basic things a hospital needs to do to deliver safe care."

While infection preventionists said complying with reporting mandates took up too much of their time, McGiffert argued that the survey findings highlighted the wisdom of public reporting requirements.

"This isn't the first survey showing that infection control is poorly resourced," McGiffert said. "This shows there is even more of a need for mandates. When these kinds of cuts are made, it reflects that infection control is not an important enough issue for these hospitals."

The Centers for Medicare & Medicaid Services has stopped paying extra for a number of hospital-associated infections. Many of these infections are not always preventable, and Medicare should reconsider its policy, the American Medical Association has said. The American Hospital Assn. did not grant an interview request by this article's deadline.

In June, Joint Commission Resources, the consulting arm of the Joint Commission hospital-accrediting body, rolled out a free tool kit to help hospital executives quantify the costs of multidrug-resistant organisms. For example, it typically costs hospitals nearly 40% more to care for a patient with methicillin-resistant Staphylococcus aureus than it does to treat a patient with an antibiotic-susceptible staph infection.

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Infection control budgets squeezed

More than 40% of infection control professionals said in a recent survey that they have experienced cuts in staffing or other resources in the last year and a half. Of those reporting cuts, here are the areas that were affected:

Area Infection professionals reporting
Reduced educational funding 74%
Reduced infection prevention budget 53%
Staffing reduction 39%
Hiring freeze 35%

Source: 2009 APIC Economic Survey: The Economic Downturn and Infection Prevention: Results of an Online Poll of Infection Preventionists, Assn. for Professionals in Infection Control & Epidemiology, June (link)

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