Intl healthcare associated infection public policy reform: a summary

Early in this decade the UK published a series of evidence-based guidelines to assist clinicians in their HAI prevention efforts. Subsequently they published Standards and a Code of Practice specific to HAIs, although the extent to which these reforms have changed the burden or incidence of HAIs in the UK remains unknown.

The UK Code of Practice appears similar to the Australian NSQHC Standards as does the decree by the UK government that organism-specific rates be used to assess change in UK's HAI experience. The UK has been vigilant in ensuring that its recommendations are reviewed regularly with necessary changes made as new or different evidence evolves.

In contrast to the UK and Australia, HAI reform in the United States has largely been driven by significant changes in reimbursement. This pay for performance model penalises those organisations with patients who develop specific preventable HAIs.

This penalty approach has been in place since 2008 however its impact on HAIs has only just been reported. Experts undertook a comprehensive study of a wide range of US healthcare organisations and reported no evidence that reductions in payments for central catheter–associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates.

In an earlier related study the investigators did report that the government's sweeping reform had impacted local infection prevention programmes by forcing hospitals to invest more time and effort in measuring, reviewing and addressing targeted infections compared to reduction efforts allocated towards infections of local importance. Where these infections differ it creates a difficult tension for infection control teams. Australian experts have begun making the same observation.

Australia's experience in implementing the new 2013 NSQHC Standards and their eventual impact are largely unknown. Undoubtedly there will be significant benefits from these reform initiatives. Clinicians, consumers and management have a unique opportunity to partner in local HAI prevention and control efforts. In 2013 with the right people, right policy, right practices and right products Australian healthcare consumers can finally enjoy safer, higher quality healthcare which includes fewer HAIs. Achieving that goal alone will enable the NSQHS Standards to be considered a success.