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Doctor-Patient Effort to Promote Safety Could Help Reduce Hospital-Associated Bloodstream Infections

By Leah Nylen, CQ Staff

October 3, 2008 -- Health care experts unveiled a new set of recommendations Friday aimed at reducing central line–associated bloodstream infections by helping health professionals and patients work together to ensure patient safety.

For instance, patients should question doctors on a procedure before it happens, or whether they have washed their hands, which places the responsibility of promoting safety on both parties.

The recommendations were released during a summit hosted by the Thomas Jefferson University and Cook Medical, a medical device manufacturer.

A new Medicare policy, which took effect Oct. 1, will cut reimbursements to hospitals when patients develop any of 10 hospital-acquired conditions that could have been "reasonably prevented." These conditions, some of which are on the National Quality Forum's "never events" list because they should never happen if reasonable precautions are taken, include such things as leaving a foreign object, like a towel, in a person after surgery, transfusing a patient with the wrong blood type, and central line—associated bloodstream infections.

The Centers for Medicare and Medicaid Services (CMS) said the policy is intended to encourage hospitals to reduce infection and injuries during hospital stays.

David Nash, dean of the School of Health Policy and Population Health at Jefferson University, said the summit's recommendations are designed to promote best practices among medical professionals.

"It's no longer acceptable for nurses and doctors to say, 'this is how I do it,' when we know there is a best practice," Nash said. "Medicine is a team sport . . . Everybody has to be on board."

Although many of the guidelines are not new ideas, Nash said this was the first national summit to call for patient involvement.

Nash took issue with the new CMS regulations, saying that guidelines aimed at changing hospital culture would be more successful than reductions in funding.

"Clearly American hospitals have made progress," Nash said, noting that there already has been a "40 percent reduction in [central-line infections] without punitive measures."

A CMS spokeswoman said the policy has given hospitals an incentive to pay more attention to the problem of hospital-associated conditions, and the summit itself illustrates the impact the new regulations have had: that medical professionals are becoming more vigilant about preventing infections that result from a hospital stay.

Central line–associated bloodstream infections occur when a patient gets an infection from a central-line catheter. The Centers for Disease Control and Prevention estimates that about 250,000 hospital-associated bloodstream infections occur each year.

Earlier this week, the Agency for Healthcare Research and Quality also announced it would launch a three-year program to reduce central line–associated bloodstream infections in hospital intensive care units.

The AHRQ program will provide $3 million to 10 selected state hospital associations. The hospital associations, in turn, will teach hospital staff about a set of five simple steps to reduce infections. The guidelines, developed by Johns Hopkins University, include such things as ensuring adequate hand-washing before procedures and fully draping patients.

The AHRQ program "is a modest but important investment," Nash said. "On the other hand, $3 million to 10 states is not going to go very far."

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