Feds allocate $40 million for state HAI prevention
Feds allocate $40 million for state HAI prevention
'Mr. Obama, tear down this wall.'
Long known to open a few doors, cold hard cash may now bring down walls as well. The longstanding metaphorical wall between public health and hospital infection control is coming down in a number of states as $40 million in federal Recovery Act funding is dispersed for projects and initiatives to prevent health care-associated infections (HAIs).
The Centers for Disease Control and Prevention awarded the funds under the American Recovery and Reinvestment Act, meaning this is as close to a "bailout" as beleaguered infection preventionists are going to get. The ultimate benefactors may be the public, however, as state health departments must use the money specifically to strengthen HAI prevention efforts.
"This money is going to help states establish bona fide programs on preventing HAIs," says Chesley Richards, MD, deputy director of the CDC division of Healthcare Quality Promotion. "This has not been an area that most states have worked on previously. Just establishing a program in a lot of states will be an important step forward. We think it is something that can bring down some of the artificial barriers between public health and health care."
For example, funding will be used to strengthen the partnership between health care facilities and health departments in using the CDC's National Healthcare Safety Network (NHSN), a surveillance system that allows HAI data to be tracked, analyzed, and compared for prevention efforts.
"In order to make the kind of impact on this problem that we really think is possible, we need to have good data on how many of these infections are occurring and how they are going down with the various prevention activities that we do," Richards says. "NHSN is already being used by 40% of all U.S. hospitals — that's over 2,300 hospitals. We are seeing more and more states and hospitals use this as a tool for prevention. That is very important for the future so that when you compare hospitals or states, you know that the data is actually comparable."
State projects funded under the $40 million distribution include creating or expanding state and local efforts to implement recommendations in the U.S. Department of Health and Human Services (HHS) HAI Action Plan. Efforts will focus on HHS priority targets such as bloodstream infections, surgical-site infections and catheter-associated urinary tract infections, and will address pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff). The money also is being used to hire and train public health staff to promote and lead HAI prevention initiatives. The investment represents the first time Congress has appropriated HAI prevention funds specifically to states.
In addition, $10 million of a funding level originally set at $50 million has been allocated to the Centers for Medicare & Medicaid Services (CMS) to upgrade infection control oversight of ambulatory care settings.
"One of the reasons that this has become more of a public health problem is that [infections] are increasingly outside the hospital — for instance, the outbreak of hepatitis in Nevada," Richards says. "That's an example of an infection that is totally preventable, but is occurring in settings like ambulatory surgery clinics were you don't have the kind of attention to [needle safety and] infection control that you see in the hospital."
National framework forming
The CDC is working with CMS to collect the ambulatory care data in the NHSN as well, creating the framework for a national surveillance system on all manner of health care infections and delivery settings. "We expect these programs to strengthen tracking and prevention of health care-associated infections, enhance facility accountability, provide data for informed policy, and ultimately save lives," says Thomas Frieden, MD, MPH, CDC director.
The latest CDC estimates are that 1.7 million Americans contract HAIs annually and 99,000 of them die. In addition to the significant toll on patients' lives, HAIs represent an estimated $30 billion in added health care costs.
However, there is power in prevention. Some states have shown quick reductions after implementing prevention efforts, and others have sustained low infection rates over an extended period of time. For example, in the first six months of 2009, hospitals in Tennessee achieved a 30% reduction of bloodstream infections associated with central lines. With such efforts already under way, the state successfully applied for some $2.1 million in additional funding to bolster and expand HAI efforts, reports Marion Kainer, MD, MPH, director of the Tennessee Department of Health Hospital Infection and Antimicrobial Resistance Program, and HAI prevention lead for the Council of State and Territorial Epidemiologists.
"The money is going to help us create new positions with expertise in health care- associated infections so we can expand some of our surveillance activities towards our infection preventionists in hospitals," she says. "We will be providing additional training and education for IPs."
Some of the training will be aimed at improving reporting using the NHSN system, honing analysis of the data so they can be used for quality improvements. The state health department also is strengthening collaborative efforts with the state hospital association to prevent HAIs, which are subject to public reporting as they are in many other states.
"The overarching goal — which every hospital should participate in — is improving the culture of safety," Kainer says. "We are planning on doing education and training, but a large portion of [funding] will also be used to perform validation to make sure that we are confident in the data that are being reported. Since these data are going to be reported to the public, we need to be confident that these are true reflections of the rates so that we know that we are truly having an impact and there is a level playing field — there isn't any hospital gaming the system."
The funding allows the health department to strengthen its partnership with the state hospital association in the Tennessee Center for Patient Safety, the center for collaborative efforts linking all branches of health care in HAI prevention.
"If you have the hospital association speaking to hospital leadership — they pay a lot more attention," Kainer observes. "I have to say I'm really delighted to be part of this partnership. One of our next steps is to get a new needs assessment from our infection preventionists. We want to make sure that we fully understand what the current training needs are. Also, we want to get a better understanding of which additional surveillance activities IPs would find most useful for their own needs in their facilities."
For example, a number of IPs are reporting increasing problems with C. diff, making it a potential target for a collaborative prevention program using standardized surveillance definitions that enable hospitals to track and compare results. "I really want to make sure I get a good feeling of what the priorities are on the ground from the IPs," Kainer says.
The American Recovery and Reinvestment Act of 2009, Public Law 111-5 (ARRA) was signed into law on Feb. 17, 2009. Eligibility for the supplemental awards was limited to the health departments of the 50 states, the District of Columbia and the Commonwealth of Puerto Rico. In addition, health departments in the following states were eligible for supplemental funding through their participation in the Emerging Infections Program: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Tennessee, and Oregon.
The question of whether the projects will receive future funding is somewhat unresolved, but the CDC hopes to show that a focus on HAIs can wring out wasteful spending and save patient lives. That moves the HAI prevention project into the health care reform effort, raising the possibility that the infrastructure established now can be maintained as an ongoing quality assurance measure. "We think this is a fantastic opportunity in public health to really have an impact on a growing problem," Richards says. "As we enter into health care reform — and think about how public health and health care can be more closely aligned — it is a particular area where that fits nicely."
Long known to open a few doors, cold hard cash may now bring down walls as well.Subscribe Now for Access
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