1. Building a Business Case for Infection Prevention Program Dr.Manaf Alqahtani, MB Bch BAO (Ireland),MMM (Master Medical Manag.USA) FACP(USA),FRCPC (Canada) Consultant Infectious Diseases &Clinical Microbiologist Chairperson, Infection Control Program Associate Prof. RCSI-MUB

2. Objectives 1.Societal impact of HAI 2.Does Infection Control Program control infections 3.Successful IC Interventions at BDF 4.Nuts and Bolts of making a successful Business Case Making The Business Case for Infection Prevention 2

3. Number One Reason for a Business Case -Infection Prevention has now not only become necessary for the survival of the patient, but also for the survival of the facility 3

4. Societal Impact of HAI Beyond excess healthcare costs…… Indirect costs to family and caretakers Years of productive life lost Emotional /Social burden Decrease trust in the healthcare system Increase use of antibiotics Making The Business Case for Infection Prevention 4

5. Reasons for a Business Case ALTRUISM: Wish to prevent suffering & death - necessary & laudable goal, but does not pay the bills REALISM: Life’s circumstances do not allow you to work for free PRAGMATISM: You need the resources to carry out an effective Infection Control Program Making The Business Case for Infection Prevention 5

6. Ignaz Philipp Semmelweis 6Making The Business Case for Infection Prevention

7. (%) Semmelweis IP, 1861 Maternal mortality rates, First and Second Obstetric Clinics, GENERAL HOSPITAL OF VIENNA, 1841-1850 Making The Business Case for Infection Prevention 7

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9. Maternal mortality rates, First and Second Obstetric Clinics, GENERAL HOSPITAL OF VIENNA, 1841-1850 Intervention Semmelweis IP, 1861 May 15, 1847 Making The Business Case for Infection Prevention 9

10. Infection Control and Quality Healthcare in the New Millenium Are there lessons to be learned ? Recognize Explain Act Pittet D, Am J Infect Control 2005, 33:258 Making The Business Case for Infection Prevention 10

11. Does infection control control infections ? Making The Business Case for Infection Prevention 11

12. SENIC study Study on the Efficacy of Nosocomial Infection Control 0% 10% 20% 30% Relative change in NI in a 5 year period (1970-1975) -31% -35% -27% -32% -40% -30% -20% -10% With infection control 14% 9% 19% 26% 18% Without infection control LRTISSIUTIBSITotal Haley RW et al. Am J Epidemiol 1985;121(2):182-205 50% Making The Business Case for Infection Prevention 12

13. SENIC Study on the Efficacy of Nosocomial Infection Control 1 infection control nurse per 200 to 250 beds 1 hospital epidemiologist per hospital (1000 beds) Organized surveillance for nosocomial infections Feedback of nosocomial infection rates Haley RW et al. Am J Epidemiol 1985;121(2):182-205 per 110 beds Making The Business Case for Infection Prevention 13

14. Making the Business Case for Preventing HAI We all know this…do our healthcare executives know this? Making The Business Case for Infection Prevention 14

15. Making The Business Case for Infection Prevention 15 Making the Business Case for Preventing HAI Effective IPAC Program in place Effective IPAC Program in place

16. “While society would benefit from a reduced incidence of nosocomial infections, there is currently no direct reimbursement to hospitals for the purpose of infection control, which forces healthcare institutions to make economic decisions about funding infection control activities. Demonstrating value to administrators is an increasingly important function of the hospital epidemiologist because healthcare executives are faced with many demands and shrinking budgets.” Raising Standards While Watching the Bottom Line: Making a Business Case for Infection Control: Eli N. Perencevich, MD, MS; Patricia W. Stone, PhD, MPH, RN; Sharon B. Wright, MD, MPH; Yehuda Carmeli, MD, MPH; David N. Fisman, MD, MPH, FRCP(C); Sara E. Cosgrove, MD, MS Infect Control Hosp Epidemiol 2007; 28:1121-1133

17. The business of health care epidemiology: Creating a vision for service excellence Victoria J. Fraser, MD, Margaret A. Olsen, PhD, MPH, St Louis, Missouri AJIC: 30:2, April 2002

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19. Focus On Interventions at least 35-50% of all healthcare-associated infections are associated with only 5 patient care practices: Use and care of urinary catheters Use and care of vascular access lines Therapy and support of pulmonary functions Surveillance of surgical procedures Hand hygiene and standard precautions Making The Business Case for Infection Prevention 19

20. Healthcare-Associated Urinary Tract Infection Urinary tract infection (UTI) causes ~ 40% of hospital-acquired infections Most infections due to urinary catheters 25% of inpatients are catheterized Leads to increased morbidity and costs Making The Business Case for Infection Prevention 20 National Healthcare Safety Network 2009 Global Patient safety research network, WHO 2011

21. Prevention of Catheter-Associated Urinary Tract Infection (CA-UTI) Avoid unnecessary catheterization Two main principles Limit the duration of catheterization Making The Business Case for Infection Prevention 21

22. Making The Business Case for Infection Prevention 22 Preventing 13% of CAUTI  saved BHD 38,220

23. Incidence density of CAUTI decreased by 13% following a reminder interventionIncidence density of CAUTI decreased by 13% following a reminder intervention Results were maintained after 2 yearsResults were maintained after 2 years Less indwelling urinary catheters placed in the medical WardsLess indwelling urinary catheters placed in the medical Wards Decrease UTI antibiotic-related consumptionDecrease UTI antibiotic-related consumption Making The Business Case for Infection Prevention 23 Prevention of Catheter-Associated Urinary Tract Infection (CA-UTI)

24. Compliance < 40% Making The Business Case for Infection Prevention 24

25. Alcohol-based handrub at point of care A ccess to safe, continuous water supply, soap and towels 2. Training and Education 3. Observation and feedback 4. Reminders in the hospital 5. Hospital safety climate + + + + The 5 core components of the WHO Multimodal Hand Hygiene Improvement Strategy 1. System change Making The Business Case for Infection Prevention 25

26. « Success story – Key Parameters » System change Education of healthcare workers Monitoring and feedback of performance Administrative support Leadership and culture change Making The Business Case for Infection Prevention 26

27. Making The Business Case for Infection Prevention 27

28. 1. Develop a Mission Statement Improve patient morbidity and mortality by reducing hospital acquired infections through (cost effective) evidence based practices - make sure it is in line with the mission of the facility - keep it simple and defensible - it becomes your “Constitution” - one can always refer to the Mission Statement to keep the program on track Making The Business Case for Infection Prevention 28

29. 2. Frame the Problem and Develop a Hypothesis About Potential Solutions The problem is HAIs and their economic costs to the facility Use your data (shown in previous slides) to demonstrate the costs Determine which interventions would be necessary to reduce HAIs Determine the resources needed Develop a budget based on this Making The Business Case for Infection Prevention 29

30. 3. Meet With Key Administrators Director of Quality Improvement, Chief Medical Officer, Chief Financial Officer - Obtain agreement that this is of institutional concern & has the support of hospital leadership - Learn from this meeting who else within the facility are key players and who should be included in developing the business plan - Learn of other costs to consider in the plan Making The Business Case for Infection Prevention 30

31. 4. Determine the Annual Costs Personnel costs Equipment - computers - copiers - fax Software programs Space Supplies Communications Education (CME) Making The Business Case for Infection Prevention 31

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33. 5. Determine What Costs Can Be Avoided Through Reduced Infection Rates From your surveillance data determine the number of infections you are experiencing in each of the categories surveyed (devices, MDROs, SSIs) Decide what you are going to target Making The Business Case for Infection Prevention 33

34. 6. Determine the Costs Associated With the Infection of Interest at Your Hospital If your institution can do this, determine the costs associated with each device infection, SSI and MDRO Otherwise, use the literature (which to choose?) Some software can do this for a price (Med Mined) The number reduced X the associated cost = the savings in that period of time (not really) Making The Business Case for Infection Prevention 34

35. 7. Now Calculate the Financial Impact Do it for each type of HAI you are trying to prevent Calculate three ways using the mean, low end and high end attributable cost. The result will be a range Subtracting the costs of the Program The result is the anticipated savings Making The Business Case for Infection Prevention 35

36. Necessary Data for Initial Business Plan Number and type of HAIs over period of time (in- house) Attributable cost for each type of HAI (in- house or literature) Payor mix Listing of what CMS & other third party payors will not reimburse Personnel costs Equipment - computers - copiers - fax Software programs Space Supplies Communications Education (CME) Making The Business Case for Infection Prevention 36

37. 8. Include all Financial Benefits Do it for each type of HAI you are trying to prevent - Devices (CAUTI, CLABSI, VAP - SSIs (KPRO, HPRO, CABG, Colon, Hyst, etc.) - MDROs (MRSA, VRE, C diff, gram negative bacilli Making The Business Case for Infection Prevention 37

38. 9. Make Your Case Do not immediately take your plan to the “highest of the high” Discuss it with unit managers, various vice- presidents, department managers, etc. Tweak, build consensus Get ideas for the implementation plan Now you are ready Dooley RS, Fryxell GE, Judge WQ. Belaboring the not-so-obvious: consensus, commitment, and strategy implementation speed and success. J Management 2000; 26:1237-1257. Making The Business Case for Infection Prevention 38

39. 10. Never Stop Collecting Cost & Outcome Data Imperative to show what has occurred after an intervention Once HAIs become low, rate of savings return lessens Administrators may think of cutting budget Use this data to show what could happen without a continued program Making The Business Case for Infection Prevention 39

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41. State/country epidemiology program International surveillance systems Financing bodies Patient safety promotion Healthcare system: -Hospitals -Ambulatory services -Nursing homes -Long-term care facilities -Home care delivery systems Pittet & Sax, Infectious Diseases. Cohen textbook (2 nd ed.), chap.85, 2004 Infection Control and Quality Healthcare in the New Millenium Where are we going ? Multiple-task activities Multiple partners Multidisciplinary team approaches Multimodal strategies Making The Business Case for Infection Prevention 41

42. Evolving to new challenges in infection control and patient safety -Team and multidisciplinary team work -Successful interventions -Adaptability of actions -Innovations -Sustainability of actions / interventions -Leadership commitment

43. Your Infection Control Program Needs to have built a business case Simply stating, “We do good work by reducing infections and saving lives” will not generate resources Prove it with your data and the literature Making The Business Case for Infection Prevention 43

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45. ry Making healthcare safer Making The Business Case for Infection Prevention 45