Healthcare-associated infections — illnesses that people contract while being treated in a hospital or other healthcare facility — sicken millions of people each year and cost billions of dollars in additional treatment. While there has been some improvement over the years, on any given day, about three percent of the hospitalized population in the U.S. has at least one healthcare-associated infection, according to the Centers for Disease Control and Prevention.
Yet these maladies have been difficult to prevent because hospitals within a given area do not necessarily devote the requisite resources to preventing infections. As a result, patients and healthcare workers, who can travel freely between facilities, can spread infections from one hospital to another, even if some of these facilities are more vigilant than others in controlling infections.
Princeton University researchers have proposed a plan whereby hospitals receive a government subsidy that matches dollar-to-dollar the amount of money spent on infection control. Published recently in the journal Proceedings of the National Academy of Sciences, the paper calls for targeting subsidies to hospitals within a multi-hospital area that have the lowest infection rates.
Co-author Ramanan Laxminarayan, a senior research scholar at the Princeton Environmental Institute who studies antibiotic resistance, said that incentivizing infection control would reduce infections within a given region by motivating individual hospitals to strengthen their own preventive measures. Those single measures would coalesce into lower infection rates for the area as a whole.
With more than 600,000 healthcare facilities in the country, coordination is a large barrier. And without a subsidy, the authors contend, there’s no need to coordinate.
The authors said that in areas with several hospitals, some facilities may eventually get a free ride by benefitting from the effort and expense others put in. Whatever one hospital does, the benefits are felt by everyone to some extent, they said.
Hospitals that don’t commit the monetary resources to controlling infections essentially release patients back into a common catchment area, and in that way hospitals transmit infections to each other through shared patient communities.
An incentive to control infection also would go a long way in preventing dangerous bacteria from becoming immune to antibiotics, the paper found.
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The researchers used general data on hospital infection rates to develop a mathematical model to test how prevention at two hospitals would change under different incentive schemes. For example, one scenario imposed an “infection tax” that fined hospitals for each person infected, but incidents of infection did not change. The researchers accounted for hospital size, location, financial endowment and the population served, all of which had only a small influence.
Although the researchers expected that cooperators should be given the most money in order to reduce the overall prevalence of infection, the model instead showed that all of the subsidy money should be awarded to the “free-riders.”
Because these facilities would have a lower transmission rate due to the efforts of surrounding hospitals, the admission of infected patients has a proportionately larger impact, the authors said. The model showed that this outsized effect means that free riders have less incentive to invest in infection control without the subsidy.
Each day, one out of 25 patients in the U.S. contracts a hospital-acquired infection resulting in billions of wasted dollars and an eye-popping 90,000 deaths annually. A 2018 report published by The Leapfrog Group shows that the percentage of hospitals achieving zero infections has declined dramatically since 2015, indicating many patients are still at risk.
Delivering quality care has become even more essential for hospitals and health systems since Medicare started issuing penalties for high rates of hospital-acquired conditions — things such as falls, ulcers and infections that could well have been avoided. Recent statistics underscore this importance: In 2017, Medicare penalized 751 hospitals and health systems for that very reason with a 1 percent reduction in reimbursement rates for 2018.
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