Comparing RFID Solutions for Infection Control (II)
Today’s section of the series will look at the prevalence of the HAI problem using facts from the CDC. It will also discuss barriers — both observed and self-reported — to proper hand hygiene compliance.
The scope of the healthcare-acquired infection (HAI) problem: CDC Stats
According to the CDC, HAIs account for about 1.7 million infections and 99,000 deaths each year. Most of these are preventable by proper hand washing. Here are a few facts from the CDC’s March 2009 report on the direct medical costs of HAIs.
About 1 in every 4.5 hospital admissions results in an HAI.
Direct annual costs to US hospitals (adjusted for inflation) range from $28.4-$33.8 billion to $35.7 - $45 billion.
Anywhere from 30-70 percent of HAIs are preventable by proper handwashing, equaling a savings of $5.6-
$6.8 billion to $25-31.5 billion to the healthcare system with effective prevention measures.
“HAIs in hospitals are a significant cause of morbidity and mortality in the United States” (Health Public Reports, 2007).
Research shows that proper hand hygiene compliance can prevent HAIs, yet compliance rates remain shockingly low. Consider the facts from The CDC published a research multidisciplinary study on improving HHC in a special edition of its Emerging Infectious Diseases magazine[1]. The study, entitled “Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach, states that “Hand hygiene is the simplest, most effective measure for preventing nosocomial infections,” yet health-care workers’ compliance levels are unacceptably low — averaging around 50 percent
The study outlines both objectively determined and self-reported factors that influence non-compliance.
Objectively observed barriers to proper HHC:
Category |
Observation |
Professional category |
Compliance highest among nurses, relatively lower among physicians and nursing assistants |
Hospital ward |
Compliance lower when the demand for HHC was higher and risk for HAI was higher. Compliance lowest in ICU, during procedures with high risk for bacterial contamination and when intensity of patient care was high (more than 20 opportunities/hour). Compliance highest in pediatrics where activity index was lowest. |
Time of day or week |
Compliance highest on weekends |
Type and intensity of patient care (number of hhc opportunities per hour of care) |
Compliance decreased by around 5 percent (+/- 2 percent) for every 10 opportunities/hour for patient care. |
Self-reported barriers to proper HHC:
Skin irritation
Inaccessible supplies
Interference with patient-worker interaction
Patient needs prioritized
Wearing gloves - belief that it eliminates the need for handwashing
Forgetfulness
Ignorance of guidelines
Not enough time
High workload/understaffing
Lack of scientific proof of the impact of HHC on infection rates
The report suggests that interventions must be based on various levels of behavior interaction to address individual, environmental and institutional factors that influence compliance rates.
This is in line with recommendations across the board from various stakeholders who understand the importance of addressing the barriers to compliance. One of the largest stakeholder groups are infection control professionals tasked with reducing infection rates through prevention initiatives, compliance monitoring and measuring results. The next section of this whitepaper presents the opinion of one such stakeholder group who posits that surveillance technology is a key factor in preventing HAIs.
The Association for Professionals in Infection Control and Epidemiology (APIC) recently published a position paper on the use of electronic surveillance tools to prevent HAIs[2]. Without yet discussing particular technologies, this section will summarize the arguments put forth by APIC in support of surveillance technologies.
Even, or perhaps especially, those at the front lines of infection control realize the futility of manual surveillance of infection prevention compliance. APIC recognizes the necessity for surveillance technologies in this arena in order to make any significant progress in HAI prevention.
The paper states that continuous monitoring can be used to implement improvement initiatives and assess the effectiveness of interventions in addition to proving data for interfacility comparison. Technology solutions can facilitate this type of continuous data sharing.
Tomorrow, the next section of this series will review and summarize the main points of the APIC recommendation for technology surveillance tools to prevent HAIs.
Tags: health care RTLS, health reform, healthcare it, infection control, Preventing HAIs, RFID