Countering Hospital-Acquired Infections with a Culture of Safety

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Becton Dickinson’s Fiona Garín looks at the rise of Healthcare-Acquired Infections (HAIs) in Europe and how an industry-wide culture of safety needs to be developed to counter this growing threat.

 

Healthcare systems in Europe are becoming more complex in their quest to drive affordability, quality of care and patient outcomes. Cost-containment measures are in place aimed at reducing clinical and administrative waste and improving operational efficiency. There is a shift towards value-based and patient-centred care, and renewed payer emphasis on patient experience which is increasingly regarded as a potential driver of hospital performance and quality. HAIs negatively disrupt this experience.

 

HAIs are, however, not new to healthcare systems in Europe. The promise of “first, do no harm” is at the heart of all healthcare practitioners across the continuum and there have been concerted efforts to drive reductions. Today, though over one in twenty patients still acquire an HAI resulting in over 37,000 deaths and costing the European Union approximately EUR seven billion. This seems like a paradox as patient experience is at the heart of what healthcare aspires to be.

 

The development of a culture of safety therefore becomes imperative, including a culture of healthcare worker safety, a centralized and coordinated oversight of patient safety (including HAIs), and a set of metrics that reflect meaningful outcomes and allow for effective and timely decision making

Effectively preventing, diagnosing and managing HAIs will require a shift in approach, transitioning from reactive piecemeal interventions to a total systems approach in which safety is not solely dependent on the heroism of clinicians but on the design of safe systems that enable these same clinicians to make safe choices. An approach in which quality is not viewed as a project but as an integrated management system, and where there is an acknowledgement that many of these infections are not inevitable but are instead preventable. Essentially a cultural shift driving the understanding that erring is human.

 

The development of a culture of safety therefore becomes imperative, including a culture of healthcare worker safety, a centralized and coordinated oversight of patient safety (including HAIs), and a set of metrics that reflect meaningful outcomes and allow for effective and timely decision making. A culture that fosters the creation of high reliability organizations that are reluctant to simplify, are preoccupied with failure and are highly resilient. A blame-free, reporting, learning, just and flexible culture where the different actors can adapt to sudden and extreme changes in pressure, pacing and intensity and where they are incentivized to to what is right in terms fo safety.

 

The development of a culture of safety will enable leadership to tackle existing challenges impacting HAIs. External challenges such as evolving treatment practices, technologies and locations, antibiotic prescription and consumption affecting resistance, the increased rate of chronic diseases, the increased number of patients with multiple pathologies and an increased ageing population impact the incidence and prevalence of HAIs in institutions. Institutions are equally affected by internal challenges that prevent them from driving successful interventions such as staff shortages, staff turnover, limited staff training and education, obsolete technology and equipment, variation in practice, limited and strained resources, the complexity to implement safety measures, and the lack of awareness of the risks across the patient journey.

 

In future, institutions are expected to drive new priorities and behaviours and to have increased resource allocation and focus on patient safety-related issues (including HAIs). They are expected to have a higher leverage of data analytics, that will allow them to benchmark with best in class peers and to command higher payment for safer care. Process designs will be increasingly implemented to increase standardization and reliability and patients will be more involved in their care and better educated to support safer practices. Institutions, however, are also increasingly recognizing they cannot do this alone and will need to effectively partner with industry to develop and implement safe, innovative and optimized technologies, processes and systems.

 

Industry can support institutions in areas such as infection prevention, diagnostics and surveillance and reporting. They can impact awareness-building, risk assessment and compliance. Through innovative technology and automation, they can also positively affect standardization and diagnostic accuracy, appropriateness and timeliness, maximizing clinician performance and efficiency.

 

In conclusion, making a quantum leap to reducing HAIs will require multiple stakeholders to think differently, addressing multidimensional problems in a coordinated and systemic way; it will require embracing more transparency and accountability and understanding that introducing technologies, changing practice and providing education cannot happen in isolation. A culture of safety needs to flow through institutions and be leadership’s top priority to ensure sought improvements in outcomes and quality of care take place.

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