Preventing Hospital Acquired Infections And Readmissions Fines

Healthcare-associated infections cost facilities millions of dollars, but Environmental Services can stop the trend


Since 2001, the Centers for Medicare and Medicaid Services (CMS) has cracked down on hospitals where patients contracted infections during or as a result of their stay. In facilities with readmissions within one month of the initial treatment, CMS is reducing or withholding payments.

Although these “fines” have helped reduce readmission rates, roughly one in five Medicare patients still end up returning for treatment. And in August 2015, it was reported that 2,592 hospitals would be hit with penalties, resulting in a combined loss of $420 million.

Numbers like this are forcing hospitals to take notice and improve cleaning and disinfecting processes that result in reduced healthcare-associated infections. If a culture of safety is not at the heart of the organization, the health of patients, employees and the hospital’s bottom line can all be adversely affected.

And these risks and financial burdens are not trivial. According to the Journal of Medical Economics, healthcare-associated infections (HAIs) cost as much as $147 billion, annually. And according to the U.S. Centers for Disease Control and Prevention (CDC), “between 1 and 3 million long-term care residents that visit hospitals get an HAI, and up to 380,000 succumb to those infections.”

Preventing HAIs

The CDC estimates that between 5 and 10 percent of hospital patients will contract an HAI during their stay. Many of these nosocomial infections are transmitted when healthcare workers become complacent and do not practice correct hand hygiene regularly.

Although the failure of healthcare workers to comply with proper hand washing protocol has been heavily scrutinized, compliance remains low — as little as 30 percent of the time that health care workers interact with patients. And since hand washing is the first line of defense against HAIs, it’s important to implement effective rules of conduct.

But no hand hygiene program will be effective if patient rooms remain contaminated with a multitude of pathogens. Significant improvements in disinfection processes can be achieved without added fiscal commitment, through the use of evidence-based practices and properly trained and rewarded environmental services staff.

Unfortunately, a UMF Corp. 2011 survey of environmental services managers found that departments were, on average, short by five to nine full-time staff members. And despite hospital expansions, heightened services, increased patient admissions and shorter lengths of stay (creating more room turnover), many hospitals have found housekeeping an easy means of budget cutting, leaving staffs to simply dump the trash and move on to the next room. That was, until the emergence of standards and regulations that improve environmental hygiene in healthcare settings.

In 2003, the CDC’s Guidelines for Environmental Infection Control in Healthcare Facilities-Environmental Surfaces recommended that hospitals clean and disinfect all high touch surfaces. In 2007, the CMS issued an interpretative guideline for its infection prevention and control programs — they “must include appropriate monitoring of housekeeping activities to ensure that the hospital maintains a sanitary environment.”

The Association for the Healthcare Environment’s Practice Guidance for Healthcare Environmental Cleaning recommends that to ensure consistent quality of cleaning and adequate staffing resources for infection prevention, a total facility cleaning standard should be agreed upon in advance by environmental services, infection control, and operations or administrative management. By following all the recommended steps, the daily cleaning of an occupied patient’s room should take 25 to 30 minutes. A “terminal clean” after a patient is discharged or transferred requires 40 to 45 minutes, on average.