Healthcare's dirty secret

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor
If there's one topic where I feel that healthcare publications tend to repeat themselves, it's around infection control.

This is not a reflection on the writers, or the sources. It's just that it feels like the industry, both on the acute and post-acute sides, are waiting for a magic bullet to solve infection control issues. So we end up repeating the same points of hand washing, education and why reducing infections matters.

The most recent results of ProPublica's Nursing Home Inspect Tool, released Friday, reflect how many facilities are being caught by not taking infection control seriously enough. Out of the 262,500 deficiencies chronicled, the most common was the facility not being free of accident hazards (17,331), which I doubt is a surprise to anyone who regularly walks the hallway of his or her facility. The second biggest deficiency was citing a lack of an infection control program, at 14,186.

It's still rare for a long-term care facility to have a dedicated infection control preventionist, or to have a firm program and policies established. It's easy to shove aside infection control when under pressure to cut the budget, even if it's just for some marketing efforts around hand hygiene. I can almost hear the CFO grumbling, “Well, if people would just wash their flippin' hands, we wouldn't have this problem.” But there are a couple of big reasons to invest in infection control, and they have to do with some Latin words that translate into bad news.

Specifically, Clostridium difficile, E.Coli and Methicillin-resistant Staphylococcus aureus (MRSA).

It's not just that those diseases can be deadly, and in the case of C. diff, the rates may be worse than we even know. While hand washing is the most important way to keep disease from being spread, nursing home staff has to be more diligent about laundry, cleaning and isolating residents. Sometimes the culprits are the people who should know better: I'm looking at you, physicians. It's worth reading the first chapter of Atul Gawande's "Better" to understand how difficult infection control programs can be on the acute side, and how even 70% compliance is not good enough. There's also a fantastic passage in Lionel Shriver's "So Much for That" around a father who acquires C. diff in a nursing home and poses a serious risk to the main character's wife, who has cancer.

You know all of this, of course. But what you may not be thinking about is how much money infections cost the healthcare system. It's a leading reason why residents are transferred to hospitals, at a cost that's estimated to be up to $2 billion a year, according to a 2008 American Journal of Infection Control report.

We know, to a certain extent, that punishment for those who don't have an infection control program is of limited help and that it will take an Immediate Jeopardy citation or outbreak to get some facilities to act. But there is help, whether it's turning to an infection control consultant or professional association like APIC. This is one area where putting some time and money in can save not only money, but lives.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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