Infection prevention in the emergency department a hot topic among hospital leaders

What are some of the hottest issues that are top of mind for hospital leaders, and what are the nation’s top performers doing to address them?

That question was the topic of a conversation at the American College of Healthcare Executives 2016 Congress held last week. The trade group rounded up a handful of notable researchers to chew over high-level issues and health care-associated infections, or HAIs, certainly made the list. The issue has become a pressing concern for hospital leaders in recent years, thanks to some big numbers attached to them.

There were about 722,000 HAIs in U.S. acute care hospitals in 2011, and recent estimates peg the annual cost of such infections at $9.8 billion, notes Leslie Mandel, a researcher and associate professor with the Regis College School of Nursing and Health Sciences. It’s all the more concerning because at least half of the most common HAIs are preventable, she adds.

Much of the focus on addressing these infections has been on the inpatient side, in places such as the intensive care unit. And yet, other areas, like the emergency department, are rife with the possibility of HAIs. Plus, these departments often emphasize expedience over careful steps toward prevention.

“The ED is a perfect breeding ground for infection because of its settings,” Mandel says. “Patients are very diverse; there is lots of crowding, patients in the hallways separated by currents. You have people who are extremely ill, compromised, next to people who are not. It’s a challenging environment when you talk about infection.”

Relatively few hospitals have a dedicated strategy to address HAIs in the emergency department, Mandel says. She set about conducting site visits with 14 EDs in the U.S., with sustained compliance of infection-avoidance practices of greater than 80 percent. After conducting interviews with managers and holding focus groups, a few best practices stood out:

• Motivation toward infection prevention was “overwhelmingly” tied to departmental or institutional factors, rather than outside regulatory requirements.
• The use of data to demonstrate departmental infection rates is a crucial motivator in high performers.
• It’s also critical that you have a management champion who makes dropping infection rates his or her mission. “It comes from the executive suites where we sit down and we have more meetings,” one survey respondent said.
• Mandel also stressed how important it is for staff to feel that they’re accountable for patient morbidity and length of stay. There must be a culture of quality that permeates throughout the organization. “It isn’t just one person who’s the clean-hand person, it’s everybody,” one respondent said.

The bottom line is that hospital leaders should be sure to enlist both the staff and leadership of their EDs in hospitalwide efforts to improve quality.

Read more hot topics from this year’s ACHE Congress at Hospitals & Health Networks.