More healthcare mandates are not solutions – response to USA Today’s C. diff story

Peter Eisler’s article, “Far more could be done to stop the deadly bacteria C. diff,” describes the impact of healthcare-associated C. difficile infections and makes the case that healthcare leaders lack a solution to intervene resulting in much human and financial loss. The article reports that half a million Americans are affected by C. diff and the epidemic is linked to more than 30,000 deaths each year despite the U.S Department of Health and Human Services’ targeted efforts to reduce the infection. While other infections are on the decline, C. diff rates remain steady. Patients, caregivers, families and friends become casualties of the epidemic. 

The article cites healthcare providers and government agencies have been slow to adopt proven strategies to reduce infections due to cost barriers and lack of coordinated efforts by infection control and housekeeping. It is further stated that the issue boils down to lack of reporting and mandates that are said to be practiced in European countries with success. The challenge is divided into three parts: control the use of antibiotics that allow C. diff to thrive, prevent the bacteria’s spread through proper facilities cleaning and hand hygiene.

Suggested solutions place responsibility into the hands of government, healthcare and some point to hospital patients and visitors to do their part in reducing the spread of infection. Additional mandates and calls for increased reporting are believed to spur facilities to boost their efforts. The goal has been set to reduce C. diff infections by 30 percent by 2013 with little to no progress and no real solutions. Some plans are carried out with local success but a nation-wide viable solution has yet to be adopted. Healthcare, the government and the public have been independently and tirelessly battling the issue from all angles with few combined efforts. The goal to improve healthcare requires participation in a community effort to create and implement shared, reproducible and adaptable solutions.

The answer is not hindered by lack of motivation to solve the problem, but by the process in which we attempt to create solutions. Dr. W. Edwards Deming, the father of quality, said “A bad process will beat a good person every time.” Over the past 40 years, we have seen the impact of continuous improvements made in manufacturing efficiency, productivity and quality. Advancements have been made through constant process monitoring and systems dedicated to continuous improvement. The same can be done for healthcare. Healthcare must adopt active monitoring in the creation of a “health maintenance system” to foster knowledge and workflow creation in constant process improvement.

Hand hygiene is undisputed as a keystone event in reducing the spread of healthcare-associated infections (HAIs) including C. difficile. HAIs have been reported to contribute up to 79 percent of a hospital’s net losses. Hand hygiene solves many healthcare-related issues but has yet to see a broad sustainable solution for 150 years. Infection control programs save facilities money in net losses yet administrators prefer new revenue. The notion that saving money is not the same as making money is arguable when at a 2 percent profit margin, hospitals would require significant additional revenue to make up for losses associated with unreimbursed care from adverse healthcare events like HAIs.

One model for national consideration is demonstrated by a joint effort called Putting Power into Healthcare Initiative (PPHI) involving 27 Alabama hospitals targeting hand hygiene and the reduction of hospital infections.

Participating hospitals are able to install an automated hand-hygiene monitoring and communications system at a fraction of the cost to self-validate an innovative technology and communally share best practices. Results to date include improved hand hygiene by over 57 percent and reduction in infection by 18 percent. Through a collaborative initiative and community effort, hospitals have gained the opportunity to adopt and self-validate emerging technologies for integration and process improvement.

Princeton Baptist Medical Center in Birmingham, Ala., conducted a study to verify that their 22 percent reduction in healthcare-associated infections (HAIs) with use of the hand-hygiene monitoring system was reproducible. Princeton expanded the system to their medical intensive care unit for a six-month study period. HAI data trends were assessed based on infection markers which decreased by 35.1 percent when compared to the same months in the previous year. The reduction in infection markers corresponded to a decrease of 239 patient days and a reduction in net losses of $200,079. Princeton Baptist was chosen from hundreds as one of two national HIMSS/ASQ Stories of Success who demonstrated how technology helps support the six priorities of the National Priorities Partnership and The Joint Commission’s national patient safely goals and priorities. The Healthcare Information and Management Systems Society (HIMSS) and the American Society for Quality (ASQ) annually choose award recipients based on “outstanding accomplishments in the adoption and use of information technology to achieve improved patient safety, quality, effectiveness and efficiency.”

Mandates on healthcare can only be answered with viable solutions. It is our collective responsibility to produce these solutions. With continually thinning healthcare budgets, we have to work together to find creative ways to improve quality and efficiency. Increased pressures on healthcare to improve outcomes and reduce costs can be answered through a focused effort to create manufacturing-like monitoring and continual process improvement.

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