Targeting Zero Gets Big 2009 Boost

• By Jerry Laws
• Apr 01, 2009

The Association for Professionals in Infection Control and Epidemiology (APIC) began its Targeting Zero campaign in 2008, but the push actually originated in January 2006 with the publication of a 2012 strategic plan. Simple to articulate but hard to accomplish, Targeting Zero is a philosophy that health care institutions should strive to eliminate health care-associated infections, or HAIs, completely – a philosophy that APIC has backed up with webinars, conferences, and elimination guides, including several new guides being published this year.

HAIs affect nearly 2 million Americans annually, causing 99,000 deaths and about $20 billion in health costs, APIC said in its Jan. 22 announcement of 2009 Targeting Zero initiatives. A little more than a month ago, on Feb. 18, good news arrived in the form of a CDC study in JAMA, the Journal of the American Medical Association, that showed rates of MRSA central line-associated bloodstream infections among patients in nearly 600 U.S. facilities’ intensive care units fell by nearly 50 percent from 1997 to 2007.

"This is encouraging news for patients and the health care community," said APIC CEO Kathy Warye. "While central line-associated bloodstream infections caused by MRSA represent only a small fraction of the overall number of MRSA infections, this analysis demonstrates that health care-associated infections can be prevented in a very vulnerable group of patients when institutions consistently implement evidence-based prevention strategies. Now it's time for health care leaders to turn their attention to the 67 percent of MRSA that occurs outside the ICU -- on floors where people are being treated for general medical conditions like diabetes, pulmonary, and cardiac problems.

"For reductions in HAIs to be sustained, adequate resources for the infection prevention profession must be deployed," Warye added. "Despite the current economic stress, now is not the time to ease up on efforts to prevent infections. APIC's 2008 MRSA Pace of Progress report revealed that while three-quarters of hospitals have increased efforts to control the spread of MRSA, more than half say they could and should be doing more. Prevention of HAIs requires consistent application of proven measures throughout the health care system and the commitment and active engagement of hospital leadership so that infection prevention becomes a part of everyone’s job."

Joint Commmission Conference Set for May 5-6
Meanwhile, the Joint Commission's "Hospital-Acquired Conditions: Solutions to Achieving Clinical and Financial Success" conference will take place May 5-6, 2009, at the commission's Oakbrook Terrace, Ill. conference center. The conference is focused on balancing the clinical and financial strategies to reduce the frequency of hospital-acquired conditions. The Centers for Medicare and Medicaid Services instituted a new policy in October 2008 under which Medicare no longer pays hospitals at a higher rate for the increased costs of care when a patient is harmed by certain hospital-acquired conditions unless that condition is documented when the patient is admitted. The early bird fee of $695 to attend the conference will expire April 5. To register for the conference, call customer service at 877-223-6866.

APIC's 2009 Efforts
APIC, an association with 12,000 members, seeks to improve health and patient safety by reducing risks of infection and other adverse outcomes. The association’s 2009 Targeting Zero efforts include new elimination guides for ventilator-associated pneumonia, catheter-associated urinary tract infections, catheter-associated bloodstream infections, MRSA in long-term care settings, and acinetobacter baumannii (drug-resistant pathogenic bacteria). APIC also said it would conduct a follow-up survey this year to its MRSA Prevalence Study issued in 2007.

A July 18, 2008, APIC position statement spells out the Targeting Zero philosophy and history. "With a declining arsenal of antibiotics to treat infections, it was increasingly clear that the traditional orientation toward control of HAIs needed to shift to one where preventing the occurrence was the priority throughout the institution," the statement says. "APIC was hearing from leaders across the spectrum of healthcare from providers to patients and patient safety advocates. It was in this context that APIC's leaders agreed that the Association should be at the forefront in promoting significant and sustained reductions in preventable healthcare-associated infections.

"Since that time APIC has moved forward to promote prevention and provided members with a host of resources to help them set and reach ambitious goals for reduction of HAIs. Targeting Zero encourages all organizations to set the goal of elimination rather than remain comfortable when local or national averages or benchmarks are met. Every single HAI impacts the life of a patient and family -- even one should feel like too many.

"APIC also believes that willful non-adherence by health care workers with proven infection prevention and control measures should be unacceptable. References to 'zero tolerance' today are generally intended as a response to unsafe behaviors and practices that place patients and health care workers at risk. In the context of HAIs, zero tolerance doesn’t mean that people or organizations should be penalized for infections that may not be preventable, but this language may be used to stress the need for accountability and a culture built on inquiry and learning as opposed to punishment."

According to APIC, a culture of targeting zero health care-associated infections has these characteristics:

• Setting the theoretical goal of elimination of HAIs
• An expectation that infection prevention and control (IPC) measures will be applied consistently by all health care workers, 100 percent of the time
• A safe environment for health care workers to pursue 100 percent adherence, where they are empowered to hold each other accountable for infection prevention
• Systems and administrative support that provide the foundation to successfully perform IPC measures
• Transparency and continuous learning where mistakes and/or poor systems and processes can be openly discussed without fear of penalty
• Prompt investigation of HAIs of greatest concern to the organization and/or community
• Focus on providing real-time data to front-line staff for the purpose of driving improvements

The association's 2009 annual conference is set for June 7-11 in Fort Lauderdale, Fla.