HHS plans to use $50 million to prevent infections
Funding from economic stimulus package means more oversight, assistance
After reading this article, you will be able to:
- Explain where the government plans to spend stimulus money for IP
- Describe how collaboratives will help prevent HAIs
- Identify how funding will help ambulatory surgery centers
Although we’ve yet to see whether the $787 billion economic stimulus package passed by Congress in February will have a positive effect on banks or the housing market, it is likely that $50 million of that package will directly affect IPs.
During his April 1 testimony before the U.S. House Appropriations Committee, Don Wright, MD, MPH, principal deputy assistant secretary for health at the U.S. Department of Health and Human Services (HHS), stated that HHS will receive $50 million through the American Recovery and Reinvestment Act of 2009 to fund IP efforts in hospitals, ambulatory surgery centers (ASC), and other healthcare facilities.
“Broad implementation of prevention guidelines can result in reductions in healthcare-associated infections [HAI], which will save lives and reduce suffering,” Wright said in his statement. “The growing demands on the healthcare system, coupled with concerns of antimicrobial-resistant pathogens and rising healthcare costs, reinforce the imperative to address this issue.”
This announcement came after a February report from the U.S. Government Accountability Office (GAO) stating that HHS needed to take action to collect data on ASC risks. A March 2008 GAO report urged HHS to centralize its coordination of IP activities to better allocate resources and achieve consistency in data collection.
Following the money trail
Wright said that $40 million will go toward the HHS Action Plan to Prevent Healthcare-Associated Infections, which debuted earlier this year and focuses specifically on ways to prevent surgical site infections, central line–associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, and C. diff and MRSA.
The remaining $10 million will be used by the Centers for Medicare & Medicaid Services to initiate a new IC survey instrument for ASC inspections, Wright said.
“Inspections have proven to be potent deterrents to relaxed infection control practices and, thus, have much potential for preventing healthcare-associated infections,” Wright testified.
Specifically, the money will allow each state to hire one to four additional surveyors, depending on ASC growth. This will allow for more inspections, at the rate of approximately once every three to four years, rather than once every 10 to 14 years, Wright said.
“As care has exploded in outpatient settings, oversight of these facilities has not kept pace,” Wright said in his testimony. “If ambulatory surgical centers or any other healthcare provider compromises on the fundamentals of safe practices, such as safe delivery of injections and medications, patients will suffer the consequences.”
This additional oversight should help mitigate the basic IC problems that ASCs have seen over the past decade (see “Ambulatory surgery centers face IC crackdown” on p. 5), including safe injection practices and sterilization, says Kathy Warye, CEO of APIC in Washington, DC.
“It doesn’t get any simpler than [safe injection practices], and these clinics have broken that basic practice, primarily by reusing syringes,” Warye says. “So what that tells us is there is a desperate need for additional education, awareness, and additional oversight. So we are very pleased to see the $10 million allocated specifically to ambulatory care, and we stand ready to help in that area.”
Breaking down the $40 million
The remaining $40 million to support the HHS Action Plan will be available to all 50 states, the District of Columbia, and Puerto Rico to help increase state and local efforts to monitor and reduce HAIs, said Richard E. Besser, MD, acting director of the CDC, before the appropriations committee.
“By creating state health department capacity in HAI prevention, a capacity similar to that which exists in states for foodborne illness prevention, immunization, chronic disease prevention, and HIV prevention, HAI prevention will grow from small efforts at a few hospitals to sustainable statewide efforts with large measurable impact,” Besser said in his testimony.
Besser added that the money will fund three measures specifically (see ”Three areas of funding” below), but Warye says the most important initiative will fund state collaboratives that combine evidence-based best practices with education and implementation involving all types of healthcare workers, including clinicians and frontline staff members.
Shortly after learning about the stimulus funding, APIC conducted a poll of its 12,000 members asking them how they would spend the money. The top response was to fund actual intervention measures, and the second highest was education of healthcare workers other than IPs, Warye says.
“Those collaboratives could provide the vehicle and the framework to do both: to enhance the interventions that protect patients from infections and provide additional education to the other clinicians and bedside workers—healthcare personnel that really are in need of this additional knowledge,” Warye says.
Improving healthcare economics
Aside from the assistance that hospitals and ASCs will see in the way of oversight, education, and statewide interventions, this funding could serve as a large boost to the healthcare system and the economy.
In their testimonies, Besser and Wright acknowledged that, in 2002, the CDC estimated HAIs were responsible for 1.7 million infections and 99,000 associated deaths. Additionally, they pointed to a February report by the Division of Healthcare Quality Promotion; the National Center for Preparedness, Detection, and Control of Infectious Diseases; the Coordinating Center for Infectious Diseases; and the CDC, which reported that HAIs incur an estimated $28 billion–$33 billion in excess costs each year.
Therefore, this stimulus money is not only potentially saving lives and protecting patients, but it could significantly reduce healthcare costs, Warye says.
“We know that interventions to prevent healthcare-associated infections cost pennies on the dollar in comparison to what those infections cost our nation once they occur,” Warye says. “So this investment of $50 million could literally save us billions of dollars in healthcare expense over the long term. So from the economic perspective, we think this is an excellent investment not only in patient safety, but in reducing the cost to our healthcare system overall.”
Three areas of funding
In testimony before the U.S. House Appropriations Committee, CDC acting director Richard E. Besser, MD, said he anticipates the $40 million will fund the following:
- Collaboratives: Besser said the CDC would create or expand state-based healthcare-associated infection (HAI) collaboratives that will follow U.S. Department of Health and Human Services recommendations and use the CDC’s National Healthcare Safety Network to measure outcomes. Resources from state hospital associations and Quality Improvement Organizations would combine with the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services.
- State-specific help: This would enhance the ability for each state to assess where HAIs are occurring and how to implement proper interventions.
- Enforcement: A public health work force would be added to state health departments to ensure progress toward national goals, Besser said.