Hospital Leadership Is Vital to Protect Patient Safety, Avoid Infections

A new report from the Centers for Disease Control and Prevention (CDC) is a reminder of how far we’ve come — and how far we still must go — to keep patients safe from infections.

The CDC reported in the New England Journal of Medicine that patients were 16 percent less likely to have a health care-associated infection (HAI) in 2015 than they were in 2011. On any given day, however, about one in 31 hospital patients has at least one HAI, the CDC reports. 

There are many factors driving this progress, including growing acceptance among clinicians and management of best practices in infection prevention and control (IPC), improved supplies and technology, and better electronic medical record tools. Certainly, attention has been focused on the problem with the financial penalties Medicare imposes on hospitals with high infection rates. 

Research points to a strong association between lower infection rates and the use of professional infection preventionists (IPs) in health care facilities — a connection hospital executives intuitively understand. A survey of 234 hospital C-suite executives conducted last year by the Association for Professionals in Infection Control and Epidemiology (APIC) found that 86 percent agree that the IP plays a critical role in improving patient health and safety in their hospital, and those who work most closely with the IP are most likely to recognize the importance of the role.

But despite the value demonstrated by IPC as a recognized clinical profession, the deployment of IPs remains a matter of local preference, and they may be underutilized. For example, hospitals whose IPC programs are led by a certified IP have significantly lower rates of MRSA bloodstream infections than those that are not led by a certified professional. A strong IP is a technical expert, a persuasive leader, a clinician’s partner, and an incisive data and process analyst. 

To optimize the value of your IP and your IPC program, here are three guiding principles: 

First, you need a clear line of sight into your organization’s performance. This requires high quality, reliable data that is visible and actionable. We need ongoing surveillance to identify infections, data mining tools to understand root causes and patterns among infections, and aggregation and trending to confirm and sustain improvement using the best available benchmarks and evidence-based practice. We need to allocate the resources to ensure that the IP has the time and methods to do the job effectively, with a reasonable number of IP staff, data tools, and analytic resources.

Second, you need to challenge the mindset that infections are a natural and unavoidable side effect of care. The operational mantra needs to shift from one of “expected complications” to “avoidable infections.” As with all our work in patient safety, this needs to be based in a fully accountable, but blame-free, professionalism that focuses on systems and behaviors which can be modified in a fair and just culture. 

Third, you need to enable IPC to benefit from the same skills, techniques and principles in use for other quality improvement and patient safety efforts. Whether you use PDSA (Plan, Do, Study, Act), FOCUS-PDCA (Find, Organize, Clarify, Understand, Select; Plan, Do, Check, Act), DMAIC (Define, Measure, Analyze, Improve, Control), or other quality methodologies, IPC is a discipline which uses the same problem definition and process reengineering as any other improvement effort. 

All of these guidelines have one thing in common. They depend on committed, knowledgeable leadership to sustain the program for continuous improvement and patient protection.

For our patients, our staff, and our professional IPs, even one preventable infection is one too many. This is a clinical program which benefits from systematic application of improvement tools and data, and which rewards us with safer patient care, safer staff, and improved financial performance. It’s well worth the attention and support of hospital leaders.

Cynthia Barnard, Ph.D., MBA, MSJS, vice president of quality at Northwestern Memorial HealthCare, Chicago, is the 2018 recipient of the APIC Healthcare Administrator Award. This is a guest column for the AHA. The views may not expressly reflect the views of the AHA.