CMS chief emboldened about infection prevention

January 12th, 2015

UPDATE: In what would be a major blow for infection prevention in health care reform, GOP moves to oust CMS chief Don Berwick http://bit.ly/hwNlaa

Surmising a recent national report of dramatic decreases in central line associated blood stream infections (CLABSIs), one of the most powerful players in health care reform sees much to like about infection prevention.

Donald Berwick, MD, is practically emboldened – as if he needed to be. A quality crusader turned administrator -- of the Centers for Medicare and Medicaid Services (CMS) no less – sees the opening of a new era in infection prevention.

“We can’t afford the human and financial costs of [HAIs],” he said March 2 at a forum on HAIs held by the National Journal. Thus – finally -- prevention speaks directly to costs, closing a loop that has snarled infection preventionists for decades as they tried to “justify” their programs. On the other unwashed hand, infections deemed preventable may be subject to reduced CMS reimbursement. This is the new paradigm that Berwick is looking over like a chess board.

“Our will is increasing -- we have better ideas, better science,” he said.

Indeed, the Centers for Disease Control and Prevention report of a 58% reduction in CLABSIs – with prevention methods including a now famous “checklist” approach for catheter insertion – is the latest triumph of science over a culture of blame.

“We understand the causes of these problems, and I think we are moving away, happily – from a culture of blame – where we just keep pointing fingers at everybody when things go wrong – into a culture of science,” he said.

As health care reform unfolds patient safety will be among the leading issues, in part because it is “charismatic,” he said. And you thought there was nothing glamorous about a UTI. On the contrary, HAIs are all the more compelling because it is becoming increasingly clear how to prevent them.

“[HAIs] are deeply connected to the overall agenda of improving quality in American health care,” Berwick said.

Likewise, the old model of the infection preventionist crunching data in a silo -- a stranger to the floors, an unwelcome sight when seen – is over.

"We are all in this together – everybody on the team doing what the patient needs. That’s the way out,” Berwick said. “People get infections that they could avoid because we drop the ball among these [health care system] fragments, these handoffs. We can learn our way out it – we know that. This amazing CDC report of a reduction in central line bloodstream infections for ICU patients in just a few years is a remarkable achievement. And it came through teamwork."