Hospital-Acquired Infections: Online Extra

The Society for Healthcare Epidemiology of America focuses on issues of patient care and healthcare
worker safety. State Legislatures asked Dr. Tammy S. Lundstrom, chair of the organization’s Public
Policy and Government Affairs Committee, about hospital-acquired infections.

State Legislatures: Do you think reducing the number of infections to zero is a feasible goal for
hospitals and states?

Dr. Lundstrom: Our goal is to eliminate all preventable infections through the full implementation
of evidence based practices for all patients. Through collaboratives involving sharing of best
practices, implementation of checklists, culture change and personnel accountability, many
healthcare facilities have reduced infections significantly. Some have achieved zero device-associated
infections in their ICUs for months at a time. However, some patients still acquire infections due to
unmodifiable patient factors.

SL: Is there a state or states that you feel has excelled in the area of policy to reduce incidences of
hospital-acquired infections?

Dr. Lundstrom: To date, most state policy has focused on transparency and public reporting rather
than infection prevention. The largest successes in infection prevention have been demonstrated
through large collaboratives such as Pennsylvania's Regional Health Initiative and Michigan's
Keystone ICU project which involve development of a patient safety culture, sharing of best
practices among many facilities and full implementation of evidence-based practices.
Multiple states mandate the use of CDC’s National Healthcare Safety Network (NHSN) for public
reporting which has allowed them to minimize many of the resource and technological challenges
that they would otherwise confront in implementing a hospital-acquired-infection reporting system.
The NHSN “model” has enabled timely and accurate reporting of hospital-acquired-infections and,
given an investment in the infrastructure to support its use, could be expanded within the states.

SL: What legislative measures do you feel are going to be most effective (or are most effective) in
battling hospital-acquired-infections?

Dr. Lundstrom: Each facility has its own unique set of infection prevention challenges. Therefore,
from a policy perspective, the most effective strategy would be to require each facility to perform a
risk assessment in order to catalogue, prioritize and act upon its own opportunities. However, this
can be accomplished via inclusion in CMS's Conditions of Participation, which are more easily
changeable over time than legislation.

Recent trends toward legislation focused on specific pathogens (e.g., MRSA and c. difficile) are of
concern because they preclude local risk assessment and the implementation of a broad range of
interventions needed to control infections. Moreover, legislation in general is not sufficiently flexible
to permit rapid response to local epidemiological trends or changes in the understanding of the
spread of infection and consequences of antimicrobial resistance.

In response to the increasing number of states mandating public reporting of infection rates, the
Society for Healthcare Epidemiology of America, the Association for Professionals in Infection
Control and Epidemiology, and the Infectious Diseases Society of America released model legislation
in 2006 to assist patient safety initiatives by giving state legislatures a template to use when
adopting legislation for the collection and reporting of infection rates.

The model legislation aims to ensure that state reporting systems are based on reliable data, adhere
to recommended practices that have been shown to reduce the risk of healthcare-associated
infections and improve patient care, protect the confidentiality of medical records, and reflect the
fact that some institutions treat more seriously ill patients. Further, the document is intended to
assist states in crafting legislation appropriate for monitoring individual institutions’ performance, as
well as providing data by which institutions and states can make state-by-state comparisons.

You can read the model legislation here.

You also can read the testimony on these and related topics by Dr. Patrick J. Brennan, past president
of the society, before the Senate Committee on Health Education, Labor and Pensions on June 24,