An Early Warning System for Surgical Site Infections: Thoughts from ICNet President and CEO Pat Beyer

Healthcare-associated infections represent an enormous challenge for the U.S. healthcare system, costing $45 billion to treat and killing tens of thousands of patients each year, the Centers for Disease Control and Prevention reports. An estimated one out of every 20 hospitalized patients will contract an HAI. Surgical site infections are the most costly HAIs to treat, at an average of $35,000 per case, higher than central-line-associated blood stream infections at $29,000 and ventilator-associated pneumonia at $28,000. SSIs cause more readmissions, more intensive treatments and extended lengths of stay, turning what should have been routine procedures into high-cost, high-tech and largely non-reimbursable care encounters.

Fortunately, new technology and protocols are providing early warning of the signs and symptoms of infections, giving clinicians precious time to head off issues early and prevent the spread of infection. Although adoption in the U.S. is just beginning to take flight, in the United Kingdom – where infection surveillance pioneer ICNet was founded – half of all surgical facilities have such systems. In 2008, the U.K. government put together rigorous requirements around tracking and reporting incidences of methicillin-resistant Staphylococcus aureus and C. difficile, while, simultaneously, the National Health Service conducted a fit-for-purpose study on automated surveillance systems.

"The government said, 'We're going to make you report and, in addition to that, we're going to study best practices in terms of treating infections and reducing them,'" says Pat Beyer, ICNet’s president and CEO.

Mr. Beyer notes that the United States, where ICNet has North American operations based in Chicago, is following suit in several ways. Since 2008, the Centers for Medicare and Medicaid Services has refused to pay the additional costs associated with several healthcare-associated infections. In addition, the Patient Protection and Affordable Care Act introduced a number of reforms that provide both carrots and sticks related to HAIs. By 2014, hospitals with the highest infection rates will be hit with a 1 percent across-the-board Medicare pay cut. Also, new penalties are already being assessed for excess rates of readmissions.

On the other hand, new accountable care organizations will be able to reap financial incentives through higher quality, and the meaningful use incentive program for health information technology is spurring adoption of systems that provide much of the data that automated infection surveillance systems need to work most effectively. "My anecdotal feedback is that this does work," Mr. Beyer says of incentive programs. "Putting money into the system encourages big infrastructure changes in healthcare IT."

As with much of healthcare, the problem is one of access. "The question is: Is there enough funding for low-volume hospitals that will still struggle with the infrastructure costs associated?" Mr. Beyer says. "There are a lot of local community regional hospitals that will struggle to afford the infrastructure needed for a good automated surveillance system. Throughout its 11-year history, ICNet has experience in bringing affordable and flexible electronic surveillance systems to more than 1,000 hospitals globally."

How it works

Mr. Beyer says the rollout process for an automated surveillance system is similar to implementing an electronic medical record. Once a system is chosen, the facility decides on a timeline to implement automated surveillance, and a project team is assembled to build the data fields and the interfaces among the hospital information system, the surgery system, the EMR and the microbiology laboratory system. When considering an electronic surveillance system, it is critical to consider whether that vendor can interface with your existing systems, and then evolve with the facility's plans for upgrades, mergers and growth, he says.

Once the facility has entered hospital-specific data into the system, local clinical practices are programmed into the infection surveillance system to establish best practices throughout the organization.

Automated surveillance does several things to help lower infection rates, Mr. Beyer says.

"Today's clinical practice is weighted heavily – too heavily – toward the clerical aspects associated with getting information in real-time," Mr. Beyer says. "So when I want to know about the new results coming from the laboratory or about my patients with positive microbiology results, I'm getting them by paper or by a phone call. With an automated surveillance system, the information arrives in real-time to the location each clinician chooses."

Mr. Beyer says automated surveillance systems are also able to "connect the dots" in a way that paper processes cannot. For example, a patient might contract C. difficile and force the hospital to find out everywhere he or she has been in the hospital. Without an automated surveillance system, a staff member would have to pull up the patient's records on the EMR, click everywhere the patient has been and then cross-reference every patient in the same location at the same time. That can take hours or even days. With an automated surveillance system, the staff member can determine in seconds where the patient has been, who has been there with the patient and whether other patients are presenting with symptoms of infection.

"I'm able to protect those other patients by acting on clinical information faster," Mr. Beyer says. Automated surveillance systems also make collective communication simple, he adds. An infection in a surgical facility needs a collaborative effort: Pharmacists have to tackle antibiotic protocols, medical staff has to examine how patients are handled, environmental services has to clean the areas and administration has to deal with the cost. "An automated surveillance system takes all four of those constituencies and gives them the same information, cut and tailored to what they need," he says.

Mr. Beyer also says that ICNet's system greatly reduces the cost and complexity of reporting data to the National Healthcare Safety Network. A few employees can populate all required fields in a surgery report with just a few mouse clicks from the automated surveillance system instead of laborious manual input from multiple hospital data systems. Hospitals have had to report data to the NHSN since January 2011. Starting Jan. 1, 2013, ambulatory surgery centers must begin reporting infection data to the network.

Challenges for smaller facilities

Although the rate of adoption of automated surveillance systems is around 25 percent in the U.S., Mr. Beyer thinks that changes taking place today will ease the financial burden of IT for smaller hospitals. "You're going to have the higher-acuity, more complex patients treated in the bigger health systems, so community facilities will be a funneling stream to larger institutions," he says.

The challenge will be to provide a clinically meaningful automated surveillance system that meets the needs of a small hospital and the constraints of its budget. "Automated surveillance systems have been developed for large, complex institutions," he says. "Now our mission is to continue to work with institutions of all sizes in the U.S. to deliver an affordable and effective solution for each facility."

He says the most important task now is to demonstrate the impact of healthcare-associated infections to hospital CEOs. "They need to realize that infections are a huge cost, including the cost of the  reputation to the hospital," he says. "Implementing automated surveillance costs a few dollars per admission, compared with $30,000 for one infection."

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