Advertisement

Infection control: Public reporting, disincentives, and bad behavior

  • Harold W. Horowitz
    Correspondence
    Address correspondence to Harold W. Horowitz, MD, Division of Immunology and Infectious Diseases, Department of Medicine, New York University School of Medicine, 550 First Ave, NBV 16S5, New York, NY 10016.
    Affiliations
    Division of Immunology and Infectious Diseases, Department of Medicine, New York University School of Medicine, New York, NY
    Search for articles by this author
      In recent years numerous initiatives have been implemented to reduce the number of hospital-acquired infections (HAIs) in the United States. HAIs have been estimated to cost between $28.4 billion and $45 billion annually (adjusting to 2007).

      Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009. Available from: http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Accessed January 10, 2013.

      Besides the monetary cost of HAIs, there are trust and confidence “costs” to the medical system: Patients who enter the hospital infection-free do not expect to become infected while hospitalized. The major sources of HAIs are devices, including ventilators, central lines, and urinary catheters, which potentially cause ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI), respectively. Recommendations based on best evidence to inform best practice have been published by the Centers for Disease Control and Prevention regarding device insertion and maintenance. Adoption of these recommendations is in some stage of development in most US hospitals. Preventing HAIs is critical from another perspective: Because they are hospital-acquired, the bacteria causing these infections may be more resistant to antibiotic agents than bacteria acquired in the community and therefore more difficult to treat. To compel hospitals to take this problem seriously, financial disincentives in the form of reimbursement reductions and public reporting of hospital-specific HAI rates have been implemented by government agencies for CAUTI and CLABSI, but not VAP.

      New York State Department of Health. Hospital-Acquired Infections-New York State 2010. Available from: http://www.health.ny.gov/statistics/facilities/hospital/hospitalacquiredinfections/2010/docs/hospitalacquiredinfection.pdf. Published Sept. 2011. Accessed January 10, 2012.

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009. Available from: http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Accessed January 10, 2013.

      2. Hospital-acquired conditions (present on admission indicator): overview. Centers for Medicare & Medicaid Services, Baltimore2011 (Available from:) (Accessed January 10, 2013)
      3. New York State Department of Health. Hospital-Acquired Infections-New York State 2010. Available from: http://www.health.ny.gov/statistics/facilities/hospital/hospitalacquiredinfections/2010/docs/hospitalacquiredinfection.pdf. Published Sept. 2011. Accessed January 10, 2012.

        • Horowitz H.W.
        Fever of Unknown Origin or fever of too Many Origins?.
        N Engl J Med. 2013; 368 (Perspectives): 197-199
        • Lee G.M.
        • Kleinman K.
        • Soumerai S.B.
        • Tse A.
        • Cole D.
        • Fridkin S.K.
        • et al.
        Effect of nonpayment for preventable infections in U.S. hospitals.
        N Engl J Med. 2012; 367: 1428-1437
        • Waters T.M.
        • Daniels M.J.
        • Bazzoli G.J.
        • Perencevich E.
        • Dunton N.
        • Staggs V.S.
        • et al.
        Effect of Medicare's nonpayment for hospital-acquired conditions: lessons for future policy.
        JAMA Internal Med. 2015; 175: 347-354
        • Haley V.B.
        • Van Antwerpen C.
        • Tserenpuntsag B.
        • Gase K.A.
        • Hazamy P.
        • Doughty D.
        • et al.
        Use of administrative data in efficient auditing of hospital-acquired surgical site infections, New York State 2009-2010.
        Infect Control Hosp Epidemiol. 2012; 33: 565-571
        • Backman L.A.
        • Melchreit R.
        • Rodriguez R.
        Validation of the surveillance and reporting of central line-associated bloodstream infection data to a state health department.
        Am J Infect Control. 2010; 38: 832-838
        • Niedner M.F.
        The harder you look, the more you find: catheter-associate bloodstream infection surveillance variability.
        Am J Infect Control. 2010; 38: 585-595
        • Lin M.Y.
        • Hota B.
        • Khan Y.M.
        • Woeltje K.F.
        • Borlawsky T.B.
        • Doherty J.A.
        • et al.
        Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates.
        JAMA. 2010; 304: 2035-2041
        • Klompas M.
        Complications of mechanical ventilation- the CDC's new surveillance paradigm.
        N Engl J Med. 2013; 368: 1472-1475
        • Magill S.S.
        • Edwards J.R.
        • Bamberg W.
        • Beldavs Z.G.
        • Dumyati G.
        • Kainer M.A.
        • et al.
        Multistate point-prevalence survey of health care-associated infections.
        N Engl J Med. 2014; 370: 1198-1208