The culprits are so tiny that they cannot be viewed by the human eye, so resilient that they are nearly invincible, and so common that they are the fourth leading cause of death in the United States.
Called health care-associated infection (HAIs), these common and unusual bacteria, fungi and viruses attack one out of 20 hospitalized patients, according to the Center for Disease Control and Prevention (CDC).
An estimated 271 Americans died each day from such an infection, the CDC said in a 2007 report. The CDC is a division of the U.S. Department of Health and Human Services.
The financial burden of these health care-associated infections is also staggering. The overall annual medical costs of HAIs to U.S. hospitals ranges from $35.7 billion to $45 billion for inpatient hospital services, according to CDC economist R. Douglas Scott II, in a 2009 report.
There are many types of HAIs, including those arising from the insertion of a central line directly into the bloodstream, surgical site infections, catheter-associated urinary tract infections and ventilator-associated pneumonia. Transmission of infectious microorganisms by hand is another common route.
Changes are underway, however.
The 2005 U.S. Deficit Reduction Act passed by Congress mandated that Medicare and Medicaid will not reimburse hospitals for treating infections that the patient did not have upon arrival. In other words, hospitals are required under law to treat HAIs and to bear the treatment costs.
The American Recovery and Reinvestment Act of 2009 allotted $50 million to support state-based initiatives to prevent HAIs.
While much of focus on preventing HAIs due to contaminated hands has been via direct observation, new tools are being rolled out, according to Ann Marie Pettis, RN, the director of infection prevention at University of Rochester Medical Center and a member of the Association for Professionals in Infection Control and Epidemiology (APIC).
“The question is ‘what is the best approach,’” Pettis said. “We will start to see some good literature, and there are several vendors with different twists.”
APIC was founded in 1972 to find an approach to controlling infections acquired during hospital stays. The Washington, DC-based association provides its 13,000 members with research, training and public policy work.
Cost is also a major issue, said Pettis, who works at two health care centers, a 750-acute care facility and a 270-bed community health care center. She noted various quotes ranged from up to $200,000 for a five-year contract to an $80,000 per year rate for a one-year contract.
One new approach, a system called HyGreen that detects alcohol on a caregiver’s hands, was recently installed at Chicago’s Jesse Brown Veterans Affairs Medical Center.
The system was developed by researchers at University of Florida hospitals and patented by Xhale Innovations. Calls to Xhale Innovations and Jesse Brown VA Medical Center regarding the cost of the system were not returned.
“Virtually all hand-hygiene products — both soap and waterless — contain an alcohol,” said Richard Melker, Ph.D., M.D., the primary inventor of HyGreen and professor at University of Florida’s College of Medicine.
The HyGreen system includes several steps. A sensor is located wherever hand-cleaning products are dispensed, and it detects the presence of the alcohol on the health care workers’ washed hands. Each health care worker wears a unique badge so the database records who washed their hands and where they were washed.
Patients’ beds also carry monitors which communicate with the health care providers’ badges. If a bedside monitor detects an “unclean” badge, it sends a signal to the doctor or nurse’s badge which in turn begins to vibrate.
The technology goes one step further: all data is recorded so hospital administrators know immediately who is following the hand-hygiene regulations.
Another product, the DebMed GMS (Group Monitoring System), was rolled out March 1 by the 65-year-old Deb Worldwide Healthcare Inc.
The real-time hand hygiene monitoring system combines data from software imbedded in its soap and sanitizer dispensers with data from compliance rate studies to show real-time hand-cleansing rates, the company said in its March 1 press release.
The Society for Healthcare Epidemiology of America, a 31-year old organization focused on prevent and control healthcare-associated infections and advance the field of healthcare epidemiology, reports that there will be 22 presentations on hand hygiene at its annual conference in April.
One of the systems scheduled to be introduced at SHEA’s conference is a water-powered hand washer developed by researchers at Porter Medical Center in Middlebury, VT.
“We’re sitting tight until we see data collected to see what is efficacious,” said APIC’s Pettis.