The Joint Commission Update for Infection Control: Joint Commission urges health care CEOs to lead the fight against drug-resistant infections
The Joint Commission Update for Infection Control
Joint Commission urges health care CEOs to lead the fight against drug-resistant infections
2010 deadline looms for patient safety goal on MDROs
The Joint Commission is calling on health care administrators to take the lead in preventing infections with multidrug-resistant organisms (MDROs), reminding them that current patient safety goals require CEOs to take responsibility for implementing programs to prevent these deadly and costly outcomes.
The initiative is outlined in a new report: "What Every Health Care Executive Should Know: The Cost of Antibiotic Resistance," a free, online multimedia toolkit developed by Joint Commission Resources (JCR) for hospital executives.
MDROs such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, Clostridium difficile, and resistant gram-negative bacteria such as Pseudomonas aeruginosa are increasingly common causes of health care-associated infections (HAIs). The threat posed by MDROs becomes more serious every day — not only because of the failure to control known pathogens but also because of the emergence of entirely new strains, which add to the burden of prevention, the report states.
"The problem of antimicrobial resistance and MDROs is increasing in spite of tremendous efforts to make reductions," said Barbara Soule, RN, MPA, CIC, practice leader for infection control services at JCR. "Although there have been some notable exceptions, we believe patients in hospitals are deeply imperiled. Leaders who effect the changing strategic direction for clinical care and patient safety are not always aware of the full magnitude of the problem."
Although some patients enter the hospital already colonized with MDROs, the majority of patients who acquire MDROs likely acquire them through contact with the health care system. Acquisition of an MDRO generally occurs without the knowledge of the patient or clinicians, but a sizeable proportion of colonized patients go on to develop overt infection that can be associated with an array of poor outcomes that include death, the JCR report warns.
"We created this toolkit as a call to action to health care executives, [urging them] to lead the charge to improve patient safety and minimize the costs related to MDROs," Soule said at a recent conference call announcing the toolkit. "At every point in the toolkit, the leader's role is emphasized. The toolkit also is designed to provide leaders with tools that they can disseminate for use up and down the hierarchy of the organization."
To give but one example from the report, the toolkit outlines strategies for CEOs to improve hand hygiene, a simple act that can prevent MDRO transmission on the transiently colonized hands of health care workers. "The involvement of the hospital chief executive is one of the most important factors in determining whether an organization pursues a path toward continuous quality improvement or slides toward mediocrity," the JCR notes. "Nowhere is this more apparent than in the institutional pursuit of maximizing hand hygiene compliance by health care workers."
As with quality interventions, the CEO carries the power of persuasion in every visit on the wards. The CEO and other leaders can directly cultivate a culture of safety and quality during leadership rounds by washing their hands when coming onto the unit or before entering any patient room, the JCR notes. Even if they are not expecting direct patient contact, the staff observation of a CEO washing his or her hands as the first action in a clinical area sends a powerful message, the report states. In addition, the leadership team should discuss hand hygiene compliance data with the management and staff of a unit, asking about compliance rates and what obstacles exist for timely and appropriate hand hygiene. As staff express concerns or make suggestions, these should be considered and a response generated after the visit to indicate that leadership is serious about making hand hygiene a priority, the JCR emphasizes.
In the research conducted to create the toolkit, the Joint Commission asked some compelling questions to CEOs. "Fundamentally, the question we asked of executives is how many patients at your institution died last year as a result of infection with an MDRO?" said Stephen Weber, MD, a JCR consultant and one of the principal authors of the toolkit. "It's a question that, frankly, most senior executives should want to be to able to answer if they are not already able to."
While there is an ethical imperative to focus on patient safety, the massive financial impact of MDROs must be a critical part of CEO engagement, emphasized Weber, medical director of infection control and clinical quality at the University of Chicago Medical Center. "Ultimately, everyone needs to recognize that each organization has to embrace MDRO control not just because it's a good clinical idea but because of the financial ramifications," he said. Indeed, the report underscores that the cost of care can be more than double for patients infected with resistant bugs rather than drug-susceptible ones.
"We would like to sit back and say that just the clinical impact of these pathogens ought to be enough for us to want to seize control," Weber said during the conference call. "But we live in a fiscal environment — seemingly more and more so every day. When it comes to the economy and health care, it would really be irrational and irresponsible not to address the financial impact of antibiotic resistance. The question that I suspect is on the minds of many CFOs, is: 'How much did it cost our hospital last year to prevent and manage infections caused by MDROs?' If you can't answer that question or someone in the organization can't provide you with that answer you ought to take a close look at [the toolkit]."
Indeed, institutional chief executives are "uniquely positioned" to contribute to the end of the era of antibiotic resistance the JCR report emphasizes. "As an advocate for patients, you are entrusted to protect their interests and safety while they are under your care," the report concludes. "As a manager and leader, you can demand that those who work under you and in collaboration with you, including physicians, meet the standards of care. As a financial leader, you are uniquely positioned to ensure that those professionals who are committed to improving care at your hospital have the tools to do so, and as an officer of the organization, you have fiduciary responsibility to ensure that the operations of your hospital are as effective and efficient as they can be. In short, the job of controlling and eradicating MDROs is the job of many, but the responsibility must ultimately be borne by organizational executives like you, rather than any other group or individual."
"The intensity and sophistication of treatment in your hospital can save patients who previously would have no antibiotic options available to them and therefore little hope for cure," the report states. "At the same time, these patients are the most vulnerable to the catastrophic effects of an MDRO infection. As the numbers of patients being saved increases, so too will the size of the population vulnerable to these infections. From a clinical perspective, the stakes have never been higher."
As big as they are, health care costs and patient consequences are not the only forces driving the MDRO issue. The JCR report advises CEOs that patient advocacy groups and the media have become more outspoken and critical in their demand for improvement in the fight against "super bugs." However until recently, clinical and policy leaders have allowed their calls to go unheeded, and the public increasingly believes that hospitals cannot or will not address this problem, the report notes. That has led to legislative action, with well-intentioned laws targeting MDRO reduction raising fears of unintended consequences.
"Many agencies, publications, guidelines and regulations are calling attention to the MDRO problem," Soule said. "The Joint Commission has increased emphasis on MDROs in the 2009 patient safety goal for preventing MDROs. What mainly distinguishes this toolkit is that it has been designed primarily for health care leaders and addressing their role in advancing to improve care."
(Editor's note: To download the toolkit, go to: http://www.jcrinc.com/MDRO-Toolkit-Overview/Default.aspx.)
The Joint Commission is calling on health care administrators to take the lead in preventing infections with multidrug-resistant organisms (MDROs), reminding them that current patient safety goals require CEOs to take responsibility for implementing programs to prevent these deadly and costly outcomes.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.