An area of quality focus in recent years has been reducing the number of bad things that happen to people when they are receiving health care. Various “never event” programs and other error reduction efforts have been underway for several years. One common problem is becoming infected, particularly when in the hospital, and the organisms responsible are often resistant to most antibiotic treatments. A report from the Agency for Healthcare Research & Quality examines the evidence on the efficacy of various approaches to reducing such infections. (AHRQ Report) There are estimated to be well over a million health care associated infections each year, with as many as 100,000 deaths attributable to them, and a cost of over $40 billion at hospitals alone. The authors found about 150 studies that examined interventions to prevent hospital or other medical facility-acquired infections. Some of these studies looked at a single infection type and others were across multiple infections.
The key question examined was the effectiveness of various intervention strategies against one or more of the infection types. The authors had difficulty identifying and disentangling the intervention strategies. They used two basic classes of intervention: organizational change and provider education. There were also interventions related to patient education and financial incentives, as well as feedback and provider reminders. In regard to central line-associated blood infections, there was moderate evidence that the basic intervention strategies, along with audits, feedback to providers and reminders improved infection rates, as did the basic strategies alone. In regard to ventilator-associated pneumonia, there was also moderate evidence that the base strategies, along with audit, feedback and provider reminders improved adherence to best care practices. There was also moderate strength of evidence regarding surgical site infections and the use of provider reminder systems, with or without the base strategies, improved rates of catheter-associated urinary infections. The authors found insufficient evidence to make a judgement on the cost or savings related to the interventions. The review is encouraging, in that it suggests that there are effective intervention techniques which will reduce the rates of infection, so it seems appropriate that medical services facilities should be penalized if they don’t do so.