Three Steps to Minimize the Risk of HAIs in Your Facility

Despite CDC recommendations, there is no law requiring infection prevention training for any construction worker or other vendor working in a health care facility.

• By Thom Wellington
• Jun 01, 2016

An alarming 5 percent of all hospital stays result in readmissions due to infections that patients acquire in the health care facility. These infections, which are widely seen as preventable and often caused by hospital conditions or human error, are known as hospital-acquired infections (HAIs). Each year, HAIs are costing health care facilities more than $30 billion and are, more importantly, claiming 99,000 lives--that's 271 lives each day.

What Happens to a Facility with High Rates of HAIs?
Under recent legislation implemented by the Affordable Care Act, health care facilities will be penalized for having high infection rates and will receive citations that cut critical reimbursement revenue.

In fact, legislators are currently pushing health care facilities to publish rates of infection for public record, and hospitals are being scored on patient satisfaction and infection rates. These scores directly impact reimbursement, to the tune of millions of dollars per facility. Recently, 30 hospitals in Florida were fined more than $300 million.

Beyond monetary deductions, health care facilities with high rates of HAIs are receiving bad publicity that could be detrimental to those facilities. One-third of hospitals open today are expected to be closed by 2020 due to poor customer service and greater transparency of hospital performance.

In turn, patients will be more selective when choosing a hospital. Once HAI rates are published, patients will act as educated consumers and visit the hospital with the best ratings and lowest probability of acquiring an HAI.

How Are HAIs Spread?
HAIs are caused by viral, bacterial, and fungal pathogens that can be airborne, waterborne, or transferred through surfaces in a health care setting. Risks of acquiring HAIs can be easily attributed to equipment or instrument negligence by health care employees. Aspergillus spp.-related HAIs account for 17-20 percent of infection and are commonly transferred through maintenance and construction-related activities in a health care facility.

Sites that generate high levels of dust from major demolition and construction activities can unknowingly transport bacteria throughout critical areas of the hospital. The areas of the hospital that are at the highest level of HAI risk include intensive care units, operating rooms, dialysis units, critical care and cancer nurseries, burn care units, trauma rooms, and outpatient clinics.

Imagine the following scenario occurring in your facility:

You are visiting a hospital while a minor renovation is underway. You never visit the floor undergoing the renovations or see any equipment. You are, however, traveling in a crowded hospital elevator when the car stops on the fourth floor and in walks a construction worker covered with dust.

He scrunches in between a hospital patient in a wheelchair and a visiting clergy member, while you count the floors passing. Embarrassed by his dust-covered clothes, the construction worker starts brushing himself off. No one thinks much of it, but now all of the people who had come in and out of the elevator are carrying a little of that bacteria-laden dust with them for the rest of their visits.

This example is one of many that illustrate how vendors employed by the facility can have a big impact on the well-being of patients. But patients aren't the only people in health care facilities to be affected by the lack of understanding of HAIs. Vendors and health care employees themselves are at risk when unfamiliar with techniques and procedures required to properly handle materials that can be supporting dangerous fungi and bacteria. Since half of Aspergillus spp. infections are caused by construction and maintenance activities, training all of the outside vendors who come into hospitals to work is critical and recommended by the Centers for Disease Control and Prevention.

The CDC and CMS require health care facilities to provide education on infection control to all construction workers and staff. Without proper training on how infections can occur and spread in health care settings, contractors and other vendors are likely to make mistakes without realizing the potentially hazardous effect.

Three Ways to Minimize the Spread of HAIs
In an effort to reduce the overwhelming number of HAIs that occur annually, the CDC requires every health care worker to become familiar with the Infection Control Risk Assessment (ICRA). Unfortunately, there is currently no standard procedure for facilities to test staff or vendors on their knowledge of the ICRA, and there is little time for on-site training in the fast-paced hospital environment. Many vendors are unaware of the contents of the ICRA and are unfamiliar with how infections can occur or spread throughout a hospital.

To reduce the impact of HAIs in health care system and maximize patient health, facilities must strive to put the following three strategies into action:

1. Implement facility-wide training programs. Research presented by the CDC shows that when health care facilities, care teams, and individual practitioners are aware of infection problems and take specific steps to prevent them, rates of certain HAIs can decrease by more than 70 percent.

By implementing a training program that addresses issues health care staff members encounter on a daily basis, every member of the facility's team will be educated to make a difference and improve patient care. There will be a noticeable shift in focus in every corner of the facility, from sheer project efficiency to maximizing safety and preventing the spread of infection.

2. Hire educated and accountable vendors. State law requires most restaurant vendors to take training courses on food handling before they enter the kitchen or begin preparing food for customers. Despite CDC recommendations, however, there is no such law requiring infection prevention training for any construction worker or other vendor working in a health care facility. CMS is now pushing enforcement to shore up this weakness.

The first step a hospital can take to improve HAI rates is to require all vendor employees who set foot in the hospital to complete a training course and learn about their role in HAI prevention. This includes HVAC, electrical, painting, plumbing, flooring, general contractor, and subcontractor vendor employees. Without a facility requirement, vendors and construction staff will remain unaware and unconcerned with the facility's infection rates.

3. Encourage feedback from patients to identify areas in need of improvement. In order to identify mishandled procedures or material that may be contributing to the spread of HAIs, patient satisfaction scores must be acknowledged by every member of the facility's team. Patients should be encouraged to learn the rates of infection for the health care facility they choose and have basic knowledge as to how HAIs spread.

Giving patients the opportunity to educate themselves about HAIs through brochures, signage, and verbal communication with their practitioners will empower them to take more control of their stay in the facility and act as additional enforcers of infection prevention. When patients have the confidence to speak up to practitioners and remind them, for example, to wash their hands before taking their pulse, the risk of infection is lowered.

The only way to mitigate the risk of HAIs--which are now claiming more lives annually than AIDs, breast cancer, and car accidents combined--is to promote awareness of how infections spread and create a facility-wide system of prevention.

Once your facility's team is educated about the impact of HAIs and their role in minimizing the spread of fatal infections, you're one step closer to a safer, more efficient facility.

This article originally appeared in the June 2016 issue of Occupational Health & Safety.