walkitout (walkitout) wrote,
walkitout
walkitout

Hospital Acquired Infections

In an earlier entry, I described a Baltimore area hospital which had addressed a serious problem it had with availability of beds in their emergency department leading to ambulances being diverted. They solved the problem by adding capacity, improving flow and making sure poor people knew how to get access to primary care at a clinic. The problem took off initially when the economic bust happened but good management brought it under control long before a boom has returned (assuming one ever will again).

In general, we are more likely to pay attention to Really Bad Things, and to lose interest as they improve. Our capacity as individual citizens to pay sustained attention to a problem to fix it in an organized way is limited -- that's why we hire professionals to do it as a job, instead.

Paying attention is pretty boring, detailed stuff: figuring out how to count something, counting it, figuring out how to increase or decrease it (whichever we decide is desirable), implement, re-assess. Lather, rinse repeat.

We can see this process in action here:

www.cdc.gov/hai/pdfs/stateplans/SIR_05_25_2010.pdf

Here's the part that's easiest to pay attention to:

"Previous analysis of NHSN CLABSI data, comprised almost exclusively of data reported before state mandates for reporting CLABSI were in place, documented annual decreases in CLABSI incidence rates among intensive care unit patients. In addition, a subset of these CLABSIs, those associated with MRSA, documented a decrease in CLABSI incidence estimated at 8-10 percent per year. This paralleled changes in population-based incidence of MRSA bloodstream infections documented from a distinct CDC surveillance program dedicated to invasive MRSA surveillance.14 This observation suggests that the national SIR in this report likely reflects rates that are truly less than the referent population rates, and not artificially low rates resulting from poor reporting. Regardless, additional steps to bolster the reliability of these HAI data include efforts planned by CDC to evaluate NHSN HAI data using external data sources, to improve assessment of training and application of appropriate methodology by those reporting to NHSN, and to develop novel measures relying more on electronically-captured data elements."

Without getting into the details, what that means is, YES, we are making progress on central line infections involving MRSA -- we've got visibility on that through two very different observations. That's great news.

There's a lot more in the report. It isn't exciting. It's people paying attention and applying the pressure that will improve care AND save money over time. This is what will bring down health care costs over the long haul.
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