The Centers for Medicare & Medicaid Services (CMS) significantly impacts clinical processes through payment systems, offering rewards for superior performance and penalties for substandard performance. One key metric that hospitals closely monitor is the standardized infection ratio (SIR) which pertains to hospital-acquired infections. The SIR is a measure that compares the actual to the projected number of hospital-acquired infections. A ratio above 1.0 indicates a higher incidence of infections than forecasted; conversely, a ratio less than 1.0 suggests fewer infections than projected.
CMS considers this ratio when determining hospital-acquired conditions’ overall score for five types of potential infections. Hospitals with higher scores receive decreased CMS payments. This penalty-focused approach has been integral in reducing hospital-acquired infections and raising awareness of the issue within hospital environments. However, the lower than 1.0 SIR is often viewed as the final goal rather than a step in the broader infection prevention roadmap. There is a worrying tendency among hospitals to shift focus to other performance aspects upon achieving this goal, instead of continually striving to curtail hospital-acquired infections.
The urgency to get better in preventing these infections should be a top-priority organizational concern as hospital-acquired infections still persist, posing risks such as unreimbursed expenses, hospital stay extensions, reputational damage, and serious adverse events, not to mention the patients’ suffering or even death. Pioneers in infection prevention have made significant strides since Ignaz Semmelweis, a Hungarian physician, linked unclean hands of physicians to maternal childbed fever in 1847. Our understanding of risk factors and protocols for infection reduction in hospitals is solid. The challenge, however, lies in changing the prevailing culture in hospitals.
Hospital culture strongly influences clinical practices, complicating the implementation of more effective process steps. For instance, central line-associated bloodstream infection, the deadliest among healthcare-associated infections, has several facilitating practices recommended by the Centers for Disease Control and Prevention (CDC). These include catheter placement and the type of catheter used. Often, these practices clash with ingrained behaviors and habits of physicians, making change challenging.
Successful organizations show a deep-rooted culture of vigilance and continuous improvement, driven by leadership commitment. Comparative performance data has been an effective tool for influencing change. But a more pronounced, rapid, and broad improvement can only emerge from situating infection prevention as a top priority for a hospital’s CEO, the board chair, the chief medical, and nursing officers. As hospitals juggle various initiatives and priorities, striving for excellence in preventing hospital-acquired infections should take precedence.