Use diverse roles to show cost controls

Link ICP salary hikes, resources to savings

Infection control professionals facing an unprecedented expansion of job duties have new opportunities to demonstrate cost savings that can lead to salary hikes and increased program resources, an ICP emphasized at the annual conference of the Association for Professionals in Infection Control and Hospital Epidemiology (APIC).

Infection control jobs today go well beyond the traditional surveillance and reporting of infections, with ICPs wearing such diverse hats as educators, environmental engineers, medical waste experts, occupational injury "gurus," regulatory interpreters, sterilization authorities, and medical device specialists, noted Robert Garcia, MT(ASCP), CIC, assistant director of infection control at Brookdale University Medical Center in Brooklyn, NY.

"Every week it seems we are some kind of new expert in some other function in the institution," he told APIC attendees in San Diego.

But the upside of that trend is access to diverse programs that can be used to accomplish goals widely coveted in today's health care climate: cost savings and bottom-line budget impact.

"We as an organization, as infection control professionals, in my opinion, are practically the most talented people in health care today - for the simple reason that we are so diversified," Garcia told APIC attendees. "Who else in the institution knows more about hemodialysis, endoscopy, operating room procedures, and things that go on in trauma, the emergency department, and sterilization? Nobody has the amount of information that we have as infection control professionals. But for those of you who haven't, we need to take one additional step. Unfortunately, it is another skill that we have to try to allocate some more time to. That is financial skill - skill in interpretation of dollars and cents in order to try to enhance our practice."

Many ICPs routinely save their institution money as part of their routine jobs or special projects, but may not be documenting the results and presenting findings to their supervisors. While the primary purpose is still to reduce nosocomial infections, ICPs who also target products and services at the hospital may better communicate program value to financial and administrative people in the institution, Garcia said.

"Don't get me wrong. I'm not saying that administrators in general don't understand the basics about an infection and its importance," he said. "[But] when you show a cost savings you can actually show the reduction directly in a budget line."

^{Product committee important}

A natural complement to the diverse role of today's ICP is membership on the institution's products evaluation committee. By serving on the committee, ICPs can determine which products are being purchased and can use the information to project cost savings, Garcia said.

"Reporting the cost impact is the other critical step," he said, recommending use of computer-generated spread sheets in quarterly reports showing savings generated by the infection control department.

In order to document savings, however, ICPs need to know the true purchase price of the item - the per-unit cost to the hospital, he said. Likewise, find out who purchases given items, because this can vary by institution or individual department. ICPs should determine initially how many items of a given product are in a standard shipment box, how many boxes in a case, and how many cases are ordered a year. Such data may be obtainable from purchasing, materials management, department directors, or the vendors. Armed with such knowledge, ICPs can project true cost savings if comparable lower-priced products are available.

For example, with a needle safety device, include not only purchasing costs, but any data on reducing needlesticks. While estimates as low as $400 per injury have been used in the literature, Garcia said the cost of a needlestick is currently running $2,694 at his institution when all postexposure follow-up, testing, and administration of drugs are factored in.

Any reductions in nosocomial infections should be reported with a cost-saving component, particularly if you have infection cost data from your own facility, he noted. If that is difficult to collect, published estimates of the cost of infections can be used to show cost savings by preventing infections, he adds.

With regard to supply purchasing, Garcia advised ICPs to winnow down multiple glove, gown, and scrub suit purchases to a few essential designs. Noting that some hospitals he has consulted with have all manner of gloves in stock, Garcia recommended narrowing purchases to a few types for the entire facility. Those could include latex and non-latex types and possibly gloves made of synthetic materials for workers with allergies.

"The question is, how many types do you use?" he said. "You have to also approach individual departments, so you might want to arrange through the products committee to send out a questionnaire asking what gloves are [staff] using and where do [they] get them from."

Likewise, he recommended narrowing the many varieties of gowns used at some facilities to three general types: an apron for non-blood contacts, a fluid-resistant model, and a sterile surgical gown.

"You [can] eliminate all of the requirements for general gown usage for nurseries, the NICU, and recovery room," he said. "There is plenty of evidence that you can do that. I have done it now for the last three years and I have not seen any changes in our infection rates - bacteremias, wound infections in our NICU. And we have a 37-bed NICU."

Garcia emphasized that ICPs must document such cost-saving efforts and use the data in "win-win" proposals to administration for salary increases or additional program resources or equipment.

"You're going to show them that not only am I able to save money for the institution, but I want a portion of that saved money to increase my salary," he told APIC attendees.