Infection Control Today

FEB 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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16 ICT January/February 2019 feature www.infectioncontroltoday.com An average of 1.7 million healthcare-associated infections (HAI) are reported in this country every year, and an estimated 99,000 cases will result in death. 1 To help put this in perspective, 99,000 would be equal to a 747-jet full of passengers crashing every day for 198 days. According to some experts, 55 percent to 70 percent of all HAIs are preventable. 2 Accordingly, 70 percent of 1.7 million or 1.2 million patient infections, could be avoided every year with the application of evidence-based infection prevention measures, when directed by a clinically expert infection prevention director and/or team. Zero preventable HAI is the goal of all IP departments, though sustained zero preventable HAI remains an aspirational goal for most locations. The fact that so many HAI are preventable should be a key message emphasized in any effective business case for Infection Prevention (IP), whether proposing additional resources, infection surveillance software, or implementation of a new product. There have been numerous peer reviewed publications which can be used to help develop a business case for the addition of a product or full time equivalent (FTE) for the IP department. Some of these papers have estimated the cost of HAI including the paper by Murphy, et al. in 20123 and by Zimlichman et al in 2013. 4 In her paper, Murphy cites a study of 1.69 million admissions from 77 hospitals that found an HAI reduced overall net inpatient margins by $286 million or $5,018 per infected patient. 3 Additional publications propose IP department staffi ng guidelines such as the study by Bartles published in AJIC this year. 5 And still others propose basic steps to take when developing a business case, including several published in Infection Control Today. 6,7 One thing is certain, one component of a business case should be the facility specifi c return on investment (ROI), whether proposing the addition of an FTE or implementing a new product. This does not necessarily need to be a complex equation. At a minimum it should refl ect the estimated cost of what is being proposed compared to the cost associated with relevant local HAI. The associated costs have been estimated with accuracy in published papers and include treatment costs, non-reimbursement, public perception, organiza- tional reputation, and lost revenue from beds occupied by infected patients. To further aid in business case development, local HAI cost estimating tools using these published costs per infection type, have been developed including those provided free of charge by the Association for Infection Control and Epidemiology (APIC) (https://apic. org/Resources/Cost-calculators ). These tools can eliminate the need to manually calculate your facility specifi c costs which are associated with healthcare associated infections. An important step while preparing an IP business case is identifying an executive champion who will provide support with local decision makers. This champion is often an infectious diseases physician but could be a chief nursing offi cer or other executive. The champion must be an individual who has infl uence with his or her peers and other clinical leaders. The business case can be short and simple or detailed and lengthy. This, of course, is dependent upon what is being proposed, as well as how much time, experience and support the IP has, such as from a local fi nance expert. It's not always necessary to generate an exhaustive document. The following four steps represent a minimum of detail that should be included in any business case for infection prevention departments. 1. Specify what problem you are addressing and the solution you are proposing. Is it a new product? more IP resources? 2. Estimate the cost of what you are proposing. 3. Determine the cost associated with local relevant HAI using a cost calculator. 4. Determine your basic ROI (HAI cost – proposed product/FTE cost = ROI). In Figure 1 on page 17 these four steps are included in a template which can be used to generate a written business case proposal. Alternatively, if time and resources permit, a more detailed comprehensive approach to business case development can be pursued. For an example, see Figure 2 on page 17. Once the proposal is prepared, a presentation should be made to the decision maker(s) in collaboration with the executive champion. Depending upon what is being proposed (product or resource), this might be the value analysis committee, human resources or it could be an individual such as the chief medical offi cer, or other local leader. The goal of any infection prevention business case is to convey the message that investing in prevention can have a profoundly positive impact on the organization's bottom line, patient safety, satisfaction and reputation. Unless the local preventable HAI rates of all types are sustained at zero, there is leverage for a business case to support the addition of a product or FTE. To those without experience or training in building a business case, the process may seem daunting. However, there are tools available to assist in estimating the costs associated with your local HAI, to determine your return on investment. But even more important is identifying an infl uential executive champion who can work with you to present the proposal to local decision makers. A successful business case will demonstrate that the investment is benefi cial to both the organization and to the patients. Sue Barnes, RN, CIC, FAPIC, is a national infection prevention thought leader and policy specialist. The Basics of a Business Case for Infection Prevention By Sue Barnes, RN, CIC, FAPIC

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