831 Effect of Public Reporting and Other Policy Changes on Infection Professionals in California: A Qualitative Study

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Patricia Stone, PhD, FAAN , Columbia University School of Nursing, New York, NY
Sarah Jordan , Columbia University School of Nursing, New York, NY
Debbie Mulligan, RN, PHN, MSN , Mission Hospital Regional Center, Mission Viejo, CA
Marcia Ryder, PhD, MS, RN , Ryder Science, San Marcos, CA
Monika Pogorzelska, MPH , Columbia University School of Nursing, New York, NY
Elaine Larson, PhD, RN , Columbia University School of Nursing, New York, NY
Background: Owing to the magnitude of the healthcare associated infection (HAI) problem in US hospitals, there have been two major policy changes in the recent past.  One is the federal policy that took effect as of October 1st, 2008 which no longer allows the Centers for Medicare and Medicaid  Services  to pay for increased costs associated with select  HAIs.   Additionally, as with many other states, beginning January 20th, 2009, each general acute care hospital in California was mandated to report select HAIs to the state’s Department of Public Health.
Objective: It was within this context, and as part of an initial evaluation of the California Healthcare Associated Prevention Initiative (CHAIPI), that we conducted a qualitative study examining infection control and prevention departments processes and practices. Methods: In-depth, open-ended interviews were conducted at six hospitals across the state in the summer of 2009.  Twenty-five hospital personnel were interviewed including hospital epidemiologists, infection preventionists, hospital administrators, nurse managers, and other personnel.  Most interviews lasted approximately 1 hour.  All interviews were audio-taped and transcribed.  Transcripts were analyzed for themes.
Results: The most common theme across setting and personnel categories was increased visibility. Increased visibility was described as the recognition of the importance of the infection control program by top hospital administration as well as increased visibility of infection prevention and control department throughout the hospital. For example, one participant stated “there is increased recognition of infection control just because of the media and the legislation…The good thing is you always want to be visible.”  Another participant stated, “knowledge and the perception of need for infection control activities is [sic] greatly heightened.”  Other common themes that were present included lack of local focus, importance of inter-committee relationships and overwhelmed staff. 

Conclusions: Federal and state policies are affecting the work of infection professionals in both positive and negative ways.  However, it is not yet clear if these changes are having the intended consequence of decreasing HAI rates.  Further follow up research is warranted.