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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Can HAI Reporting Limit Infection Prevention Presence?

FEB 27, 2019 | SASKIA V. POPESCU
Health care-associated infections (HAIs) are a considerable problem in the United States. The US Centers for Disease Control and Prevention (CDC) estimate that on any given day, 1 in every 31 patients has a HAI. Each year, 2 million Americans will suffer from a HAI and nearly 90,000 will die. Not only are these infections costly in terms of morbidity and mortality, HAIs also represent a direct cost to hospitals that ranges between $28 billion to $45 billion per year.

In the face of this problem, many states have implemented mandatory HAI reporting laws.
 
Unfortunately, these laws can negatively impact the individuals conducting the surveillance and reporting: the infection prevention and control programs. 

For many of us in infection prevention, the mandated reporting for Medicare reimbursement through the Center for Medicare and Medicaid Services is time consuming and can account for 5 hours of our work day. Now, adding in the required state reporting increases the work load.

Although most states have mandated reporting requirements, the association between state laws and HAI rates have been mixed, and few states have addressed the overall burden these laws place on the infection preventionists.

In efforts to understand how these state laws impact individuals working in infection prevention, a new study published in the American Journal of Infection Control assessed the implications for infection preventionists in states with mandated reporting laws. The investigators surveyed 1036 hospital infection prevention departments, with 73% falling in states with HAI reporting laws.

Although most of the respondent hospitals with state laws were located in the Northeast, the investigators found that those located in states with reporting laws employed a full-time or part-time physician hospital epidemiologist and had greater numbers of admissions and patient-days than those in states without reporting laws. 

The investigators found that the perceived impact of the mandated reporting on the time, resources, influence, and visibility of the infection prevention department in those states with HAI reporting was pretty substantial.

The differences in hours per week fulfilling reporting requirements was significantly higher in states with reporting laws (16.9 vs 12.4). Infection preventionists in states with HAI reporting laws also reported that they had slightly more resources to assist and more influence of the department on the hospital to drive changes than those in states without laws.

Unfortunately, infection preventionists in states with laws also reported less time for routine infection prevention duties, like rounding and education, and less visibility of the department. The investigators noted that “the need to fulfill reporting mandates and increased shift to additional surveillance activities has an important impact on the traditional role of the IP, potentially diverting IPs from activities such as education and prevention to increased surveillance and administrative work.”

Although this study has a small response rate and focused on perceived resources, time, influence, and visibility, rather than other measurable outcomes, it provides insight into a sensitive topic for efficacy of HAI reporting. A critical element of this study is that it encourages future efforts to address infection prevention staffing in the face of increasing regulatory requirements. 

As an infection preventionist, the burden of HAI reporting is daunting and extremely taxing, which leaves little time for the duties I feel strengthen infection prevention practices, like rounding on units, isolation monitoring, and staff and patient education, among others.

Reporting is critical to maintain an awareness of the overall burden and changes in HAIs throughout the United States, but it can also hinder frontline efforts, which runs counter to HAI prevention strategies.
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Big advances in treatment can't make up for an inability to stop new infections, which number 5,000 per day worldwide.
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