Navigating the Health Care System

Did you know that there is a problem in health care that causes nearly 90,000 deaths and costs billions of dollars to treat each year? It's called a health care-associated infection (HAI)—and it's preventable. That's why it's getting more attention every day.

An HAI often happens in the hospital, where patients tend to be very ill or are recovering from surgery. But this kind of infection can also occur in a doctor's office, clinic, emergency room or ambulatory setting. Patients who are elderly, very young, or who have chronic diseases, such as diabetes, also are at a high risk for getting HAIs.

Different types of bacteria cause HAIs. Some of the infections are hard to get rid of once they get into a patient's bloodstream, even with powerful medicines. That's why preventing HAIs in the first place is so important.

Hospitals in Michigan have made great progress toward reducing the risk of these infections. Doctors and nurses at 103 intensive care units used a simple checklist that reminded them of what to do to lower the risk of infections for patients who had central venous catheters, which are tubes inserted into the body to give drugs or drain fluids.

Steps on the checklist included:

• Washing their hands.
• Cleaning patients' skin with a bacteria-killing soap.
• Removing catheters when they weren't needed.

Doctors and nurses stopped and reminded each other when these practices weren't being followed in nonemergency situations. Medical staff talked about catheter infections at daily and monthly meetings.

These simple steps had a dramatic effect. Infection rates dropped to nearly zero shortly after these practices were put in place. What's more, these improvements in reducing bloodstream infections have continued at Michigan hospitals, saving both lives and money.

My Agency, the Agency for Healthcare Research and Quality, is proud to have supported the research that led to these important results. But much more work needs to be done to protect patients from getting HAIs.

In October, the Federal Government will no longer pay hospitals for the extra days that Medicare patients spend in the hospital when they get an infection after certain procedures. This new policy will get everyone to focus on how to prevent HAIs rather than on how to treat them, which often requires expensive medicines and long hospital stays.

Many other groups also are focused on reducing HAIs. The World Health Organization launched a new program called "Safe Surgery Saves Lives" that has a goal of improving surgical care safety around the world. My Agency, along with leading hospital, doctor, nurse, pharmacy, and quality groups, is a member of the Surgical Care Improvement Project. We are working to involve all staff in regular training to improve the quality of care for patients, including lowered rates of HAIs.

If you or a loved one is having surgery, there are steps you can take to lower the risk of getting an HAI. Like the doctors and nurses in Michigan, make sure you wash your hands. Ask the hospital staff to do the same before and after they provide care, such as changing bandages. Tell the nurse if you notice that bandages are not clean, dry, or attached around wounds. And tell your friends and family members to avoid hospital visits if they have a cold or aren't feeling well. Don't be afraid to speak up.

Like many diseases, HAIs are deadly and add billions of dollars in health care spending. Working together, we can eliminate many of them.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
Reduce the Risk of Health Care-Associated Infections (Transcript)

Agency for Healthcare Research and Quality
Questions Are the Answer: Get More Involved With Your Health Care
 

Agency for Healthcare Research and Quality
Having Surgery? What You Need to Know
https://www.ahrq.gov/consumer/surgery/surgery.htm

Centers for Medicare & Medicaid Services (CMS)
CMS Proposes to Expand Quality Program for Inpatient Hospital Services in FY 2009
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3041

MedQIC
Surgical Care Improvement Project: Project Information
http://www.medqic.org/dcs/ContentServer?cid=1122904930422&pagename=
Medqic%2FContent%2FParentShellTemplate&parentName=Topic&c=MQParents

World Health Organization
Safe Surgery Saves Lives: The Second Global Patient Safety Challenge
http://www.who.int/patientsafety/challenge/safe.surgery/en/

New England Journal of Medicine
An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU
http://content.nejm.org/cgi/content/full/355/26/2725