Hospital Cut-backs and Nosocomial Infections (HAI’s)

Fee For Service vs. Client Satisfaction:
Many believe ObamaCare is here to stay. ObamaCare is creating many changes, and the ripples are impacting the healthcare service sector. Due to cut-backs, service providers are seeking help and input from professionals in construction, remodeling, and consulting disciplines with the goal of reducing nosocomial infections. The reduction in hospital acquired infections will increase service scorecards. These professionals must have a good understanding of the inside workings of the medical community.

Repair Priorities:
Cutbacks have challenged repair priorities as well created opportunities for the rise in nosocomial infections.

Aging Facilities and Remodeling Relationships:
Many of our hospitals are over 50 years old. Remodeling and additions are necessary if they are to compete in this volatile market. Construction related illnesses can occur due to cutbacks in many departments. These cutbacks are having a strong influence on infection reduction resources (IR). Four out of ten hospitals are reducing IR resources. Limited and the continued reductions in IR’s are providing plaintiff attorneys additional cases. Contractors are conducting renovations within hospitals and long-term facilities with improper or the absence of engineering controls. Five thousand to seven thousand deaths are due to construction or remodeling work in healthcare facilities. The numbers are believed to be closer to fifteen thousand.

During remodeling or cleaning procedures, dust and bacteria are being aerosolized and migrate into the air conveyance systems and dispersed into critical locations. Cleaning residue left behind after surface cleanings present other problems.

Vectors:
Construction dust, ventilating air, aerosols, including waterborne act as vectors for Aspergillus and Legionella.

Biofilms:
What is a biofilm? A biofilm is any group of microorganisms in which cells stick to each other as well any living or non-living surface. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance (EPS). Antibiotic and detergent resistance can increase a thousand-fold. Biofilms are responsible for up to 85% of hospital-related infections.

Multi-drug Resistant Organisms (MDRO’s):
Multi-drug resistant organisms are emerging and entering the battle of healthcare and challenging service payments. The baby boomers are unprecedently utilizing medical facilities, unlike earlier generations, due to the size of this population. More prescriptions are being written for this population than any other generations prior. The more prescriptions that are written, the more opportunities for bacteria to become drug-resistant. As a result, biological mutations are occurring. These mutations are creating super-bugs. New research is needed to combat these new drug-resistant organisms. Prolonged hospital stays results until infections are overcome by new drug combinations.

Increased Hospital Stays:
According to a 2007 survey, adults who acquired an HAI required nineteen (19) more days compared to those who did not acquire a hospital associated illness. The additional nineteen-day stay results in cost exceeding $52,000.00. That is $43,000.00 over expected cost for a typical five-day requirement. These increased costs add up to BILLIONS in additional hospital fees (AHRG). Death rate surrounding HAI’s were six times the average (9% compared to 1.5%). Hospitals are being forced to deal with new methods in which they can minimize hospital-acquired illnesses.

Hospital Acquired (Associated) Infections or HAI’s:
Other challenges to payment reimbursements are medically resistant organisms, i.e. Methicillin-resistant Staphylococcus Aureus (MRSA) and Clostridium difficile (C. difficile, C-diff). C-diff is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis. Symptoms include Watery diarrhea (at least three bowel movements per day for two or more days), fever, loss of appetite, nausea, and abdominal pain or tenderness. Patients are more likely to get these bacterial infections as a result of hospital services. MRSA and C-Diff are also considered hospital-acquired infections (HAI’s). If a patient becomes infected, unrelated to admittance, within a 48-72 hours of the intake, the illness is more likely a result of the hospital visits or stay. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for several difficult-to-treat infections in humans. It is also called oxacillin-resistant Staphylococcus aureus (ORSA).

HAI’s:
Increased HAI’s are a serious challenge when payments are no longer available for treatments being offered when they unrelated to the original purpose for admittance. Recent data has opened the eyes of all involved, i.e., From the patient to the Carriers (Medicaid and Medicare). The following data represents increases in hospital-acquired infections:
1. Clostridium difficile – aka C. difficile or C-diff (25%),
2. Methicillin-resistant Staphylococcus aureus aka MRSA (35%),
3. Resistant Strep (28%),
4. Vancomycin-resistant Enterococci aka VRE (40%),
5. Klebsiella pneumoniae carbapenemase aka KPC or New Delhi Metallo-beta-lactamase aka NDM-1 (>50%),
6. Pseudomonas Aeruginosa (50%),
7. E.Coli (>3000), and
8. Acinetobacter Baumanii.
Pseudomonas aeruginosa is emerging as a contender to the threat of Legionella.

Multi-drug Resistant Organisms:
Multidrug-Resistant Organisms (MDRO’s) are emerging in greater numbers within hospitals and long-term facilities as the result of cutback as never seen before. As a result of Obamacare, the fee for service is going the way of the dinosaurs. The new service driven system is tied to patient outcomes, i.e., if a patient returns within the 30 days from being discharged, no payments are being provided for these new services. Fee reductions will hit hard if hospitals in your areas are receiving reimbursements from Medicaid or Medicare. For many hospitals, up to 60% of revenues result from Medicare and Medicaid reimbursements.

Hospital Forced to Make Changes Due To Economic Climate:
Hospitals have been cutting hospital cost by almost 59%. This may come through:
1. Staff reduction (53%),
2. Reducing services (27%),
3. Divesting assets (12%),
4. Considering mergers (8%), and
5. Other means (21%).

Divesting Assets:
Medical Hospitals have been forced to divest assets as a means of raising new cash and trimming cost. Without these assets, many hospitals would have been but memories of the past. These assets have been a life saver in economic times as they are facing now.

Sustainability Under Finical Challenges:
If hospitals are to continue to service the community where they presently have a footprint, they must focus on:
!. Safer Care;
2. Positive Clinical Outcomes;
3. Increased Efficiency / Lower Cost;
4. Staff and Patient Satisfaction;
5. Spread of Innovation; and,
6. Financial Vitality.

Infection Control Risk Assessment (ICRA):
The Joint Commission (aka JC), requires that all contractors engaging in activities that generate dust and or may aerosolize contaminants within critical or long-term facility MUST be ICRA trained. Training facilities, must be accredited by an approved organization.

Contractors shall have a sentinel response plan approved prior to engaging in activities. A copy must be on file with the facility IP. Projects may include, but are not limited to, any activity that may negatively impact the health of critical and long-term patients.

If you are a clinical or healthcare facility, or a contractor with plans to remodel, repair or alter a health care facility, call Environmental AirTechs at 413.569.8890 now for an ICRA survey. Planning ahead to eliminate unexpected occurrences will be the best strategy your money can buy.