Legal Implications of Healthcare-Acquired Infections

Transcription

1 Legal Implications of Healthcare-Acquired Infections Ann D. Gaffey, RN, MSN, CPHRM, FASHRM September 29, 2010 Healthcare Risk and Safety Strategies, LLC

2 Objectives 1. Participants will be able to identify at least 3 CMS-defined healthcare-acquired conditions; 2. Participants can identify three implications of healthcare-acquired conditions on an organization and/or it s patients; and 3. Participants can discuss two risk management implications of insufficient environmental services

3 What is a healthcare-associated infection? HAIs are defined as infections not present and without evidence of incubation at the time of admission to a healthcare setting Most infections that become clinically evident after 48 hours of hospitalization are considered hospital-acquired Infections that occur after the patient is discharged from the hospital can be considered healthcare-associated if the organisms were acquired during the hospital stay. Source: Mirza, A. Hospital-Acquired Infections

4 What does CMS consider a hospitalacquired condition (HAC)? Conditions that are high cost or high volume or both; Result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis; and Could reasonably have been prevented through the application of evidence-based guidelines.

5 HACs and HAIs that HES can Impact Catheter-Associated Urinary Tract Infection (UTI) Vascular Catheter-Associated Infection Surgical Site Infection Following: CABG, Ortho procedures Falls and Trauma Fractures Dislocations Intracranial Injuries Crushing Injuries Source: CMS -

6 How bad is it? HAIs affect 1.7 million hospitalizations, and are associated with 99,000 deaths in U.S. hospitals annually These infections cost $8.1 billion to treat and lead to 2.3 million total days of hospitalization In long-term care facilities, the CDC estimates an additional 1.5 million HAIs occur each year. In 1974, 2% of staphylococcus aureus infections were methicillin-resistant. By 2003, that rate had soared to an alarming 57%, and it's still rising.

7 How bad is it? Infections due to medical care made up the fifth most prevalent HAC, as studied by the Healthcare Management Council. It was the fourth most expensive category, costing $252,600 per hospital on average, and each afflicted patient, on average, requires $24,500 more in care.

8 Hits Right in the Pocketbook Hospital lost $41,913 after patient admitted with acute pancreatitis developed MRSA in the bloodstream, staying an additional 86 days. Without infection, hospital would have made a profit. Woman hospitalized for stomach-reduction surgery that would have produced a $9,900 gross profit for the hospital. She developed a central lineassociated bloodstream infection and had to spend 47 days in the hospital, leading to a $16,000 loss.

9 Hits Right in the Pocketbook Post-op wound infections more than double a patient's hospital costs, with costs increasing 119% with a post-op infection at a teaching hospital UTIs increase a patient's hospital costs by 47% at a teaching hospital and 35% at a community hospital. The average ventilator-associated pneumonia infection adds $40,000 to a patient's hospital costs. Patients with Staph infections incur hospital costs more than triple the average costs of other patients. Source: Committee to Reduce Infection Deaths: THE COST OF INFECTION: Preventing Infections Makes Hospitals More Profitable

10 What does the public know about this problem? They heard about the IOM report in ASHES Annual Conference

11 State Laws Relating to Hospital- Acquired Infections

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13 The Professional Liability Side Nov. 2008: Jury awarded $13.5 million to a Massachusetts woman who died of an infection caused by flesh-eating bacteria that she contracted during cancer treatment. Nov. 2008: Utah woman reached a confidential settlement in a $16 million suit she filed, alleging that a hospital failed to detect necrotizing fasciitis, a flesh-eating bacteria, before and after she gave birth, causing her to lose three limbs and several organs.

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15 The Professional Liability Side July 2008: Missouri couple was awarded $2.58 million after the husband contracted a potentially deadly type of staph infection, known as Methicillin Resistant Staph Aureus (MRSA), when doctors inserted a pacemaker. As a result of the infection, the patient lost a kidney and his leg and foot had to be amputated

16 How are the lawyers successful? There are CDC standards on infection prevention and lots of published materials that can be used to establish the standard of care World Health Organization recommendations on implementing infection and environmental control programs Why should someone come out of the hospital with an infection they didn t go in with?

17 We know it s a problem What Can We Do About It?

18 Contributing Factors Crowded Emergency Departments More acutely ill patients Shorter stays Lots of visitors some facilities with open units Everyone carries some bug on them Staff as a source carried in Inadequate facilities for hand washing and appropriate isolation 2010 ASHES Annual Conference

19 Where the bugs are! Germs reside on many surfaces in the hospital including bed rails, stethoscopes, faucets and the TV remote control. High Touch Surfaces: bed rails, bedside tables, IV poles, call bells, door handles, bathroom surfaces, computer keyboards, med carts, charts, and bedside commodes

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21 Role of Healthcare Environmental Responsible for: Services The regular and routine cleaning of all surfaces Maintaining a high level of hygiene in the facility Collaborating with the Infection Control Committee 2010 ASHES Annual Conference

22 Role of Healthcare Environmental Initial Training Services Establishing cleaning methods Determining frequency of cleaning Reviewing plans for renovations Ongoing training, including education on causes of contamination; ways to limit; action of disinfectants Notification of HES staff illness 2010 ASHES Annual Conference

23 Barriers to getting the job done trends in cost cutting are contributing to the decline in the provision of cleaning services and the accompanying rise in hospital-acquired infections. The research demonstrates that what we need is rigorous standards for cleaning, versus the steady cutbacks in service that we are observing.

24 Learning from other s successes Don t recreate the wheel!

25 Institute for Healthcare Improvement: Hospital Environmental Services Staff are Important Drivers of the Infection Control Agenda Aim: To decrease MRSA hospital-acquired bloodstream infections to zero by October 2008 Obtain 80 percent compliance with cleaning of rooms using all-or-nothing checklist by October 2008 Measures: Percent of inpatient rooms that meet all criteria on the all-or-nothing room cleaning checklist Methicillin-resistant Staphylococcus aureus bloodstream infection (MRSA BSI) rate per 1,000 patient days

26 IHI: Northeast Health, Samaritan and Albany Memorial Hospitals Changes Implemented for Success: Trained Environmental Services (ES) staff in high touch cleaning activities, using pictures of high touch areas for staff education to overcome language and literacy barriers Continued emphasis on proper cleaning as a mechanism to reduce infection Reviewed appropriate hand washing methods with Environmental Services staff and asked them to observe and report inadequate hand washing of ALL staff See Something, Say Something

27 IHI: Northeast Health, Samaritan and Albany Memorial Hospitals Changes Implemented for Success: Environmental Services staff actively participated in multidisciplinary team meetings to review infection control progress and outcomes Created and tested room cleaning checklist, which included high touch areas, with ES staff Tested checklist for supervisors to use on assessing room cleanliness Provided education on all-or-nothing measurement of room cleaning with checklist

28 IHI: Northeast Health, Samaritan and Albany Memorial Hospitals Changes Implemented for Success: Pilot testing of checklist began on one unit at each hospital Placed personal protective equipment outside of every patient room Placed waterless hand cleaning stations outside of every room Monitored results in all-or-nothing format and reported results back to staff on a monthly basis

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30 Institute for Healthcare Improvement: Reducing HAIs in a Skilled Care Unit St. Luke's Hospital, Cedar Rapids, Iowa, USA We should have included an Environmental Services (EVS) person on our core team. Our tests of change related to EVS were not very successful, and we believe that if we had asked an EVS supervisor to travel with us to key meetings, buy-in would have increased.

31 Since I have your attention Other areas of risk where HES staff have an integral part in prevention and mitigation: Slips and Falls Property Loss and/or Damage Hazardous waste removal Emergency Management responses Hazmat Fire Flood Water contamination

32 Thank you! Ann D. Gaffey, RN, MSN, CPHRM, FASHRM (703)