Negotiating More Resources for Infection Control

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Hit administration with numbers, facts and long- and short-term effects.

Pat Lafaro, RN, BS, CIC

Ms. Lafaro () is the director of infection control at Somerset Medical Center in Somerset, N.J., and the president of APIC of Northern New Jersey.

If the operating room is the economic engine, then the infection prevention department is the cost center, the little factory within the surgical facility where no one thinks much about what you’re doing unless something goes wrong. When all’s well, all’s quiet. But that kind of peace can sometimes lull administration into minimizing the importance of what infection control does.

They can see patients coming out of the ORs, good as new. They can see patients getting X-rays after being triaged in the ER. They can even see the results (usually on the bottom line) of your coding and billing team’s efforts. But a lot of what IC does isn’t readily empirical — especially when it comes to outpatient surgery, infection rates for which are tough to track if they’re tracked at all.

So when you find you need a bigger budget to buy software or patient education materials or to certify staff, what’s the best way to go about it? Based on my experience, here’s how you can negotiate for more infection control resources.

Pick apart your budget
This is more for you than for administration: If you know where your budget is going, you can get a grip on what can and can’t be cut and possibly find places to re-allocate funds. Generally speaking, you can expect to see your budget spread out like this:

  • 10 percent on journal subscriptions;
  • 10 percent on patient education materials;
  • 25 percent on education materials for facility staff;
  • 45 percent on staff certification, testing and continuing education; and
  • 10 percent on other miscellaneous expenses.

Other infection-related costs — supplies (such as prepping solutions and gloves) and capital equipment (such as steam sterilizers) — are usually counted under those budgets, not infection control’s. But a one-time outlay for new technology, such as infection tracking software, may fall into a gray area and could eat up most of your annual budget if you’re not prepared to ask for extra. That’s where knowing the way the numbers break down and where you have wiggle room becomes important.

Identify your needs in concrete terms
If you need something — better computer resources, the ability to perform a trial — you’ll likely be able to justify it. A bevy of new hand hygiene products may prompt the need for a trial, new literature linking patient warming and glucose control to lower infection rates may make you undertake such measures, and new standards for infection tracking may compel you to start looking at adding computer resources. In my case, an ever-increasing workload is the impetus behind my seeking to make my part-time infection control associate a full-time employee.

The tasks comprising the job of infection control practitioner have grown by leaps and bounds for the last couple years. In my hospital, not only are there additional JCAHO safety initiatives to meet, but also we’re involved with the Surgical Care Improvement Project and active in APIC. The IC practitioners sit on several multidisciplinary committees.

Doing the job right requires your getting out there among staff to check up on initiatives and compliance with protocols, conduct in-services and hold educational sessions. Healthcare workers will fall back into old habits if you don’t make your presence known; that’s just human nature. So unless you have the time to get to your staff, you’re not going to hit internal or external targets.

To justify the need for a full- rather than part-time employee, I put together a proposal that details every task required by the job description — both by the hospital and by regulations — and the amount of time it takes for her to carry them out. Right now, she spends 79 of her 80 hours a month collecting and inputting data. The time she spends sitting on committees or working on special projects, such as enacting prevention protocols during construction, are extra.

While we’re lucky to have recently purchased a data mining program specific to infection control, simply having information at your fingertips won’t cut your infection rates. It’s what you do with that data. You need to take it to your staff and use it as an educational tool: Discuss the information, make procedural changes, measure results. Unless we can get out from behind the computers, it will be tough for the hospital to derive a benefit from its investment. Freeing up my infection control associate is a matter of giving her more hours, period.

You can apply this to any quest for more resources. The key is to put together a detailed, factual proposal that is supported by data and that lists the potential benefits of the extra expense you’re requesting.

Broaden your approach
In addition to laying out the nitty-gritty for administration, take the opportunity to talk about the broader impact of the infection control department seriously.

As I said earlier, infection control can get lost in the shuffle. But your department saves lives and prevents infections, which saves your facility money. Just one SSI can cost several thousand to tens of thousands of dollars. Spending a little up front to improve resources, policies, procedures and techniques will prevent more than one SSI (see “Understanding the Impact of SSIs” on page 6 for more on their costs).

Further, JCAHO is putting more of an emphasis on infection-related patient safety goals and state legislatures are pushing for public reporting of infections. As infection control comes to the forefront, patients, physicians and insurers will put more stock into this aspect of healthcare — they don’t want to have, perform or pay for surgeries at facilities with high infection rates.

In case you think that means it’ll get hung up while legislators debate, you’re mistaken. We will have public reporting, because even if the way statistics are gathered doesn’t show the whole picture, it’s easy to present the idea as movement toward safer healthcare. When it’s spun that way, who won’t get behind it? The bottom line: It’s a matter of when, not if, public reporting happens in your state.

If we know public reporting is coming, it’s a good idea to get a firm handle on where your infection rates are now so that your statistics look good later. The silver lining to all this is that it provides an impetus for facilities to ensure the cornerstones of infection prevention — the infection control and sterile processing departments — have what they need. But it doesn’t hurt to remind administration of this.

Little factory syndrome
Infection control can feel like the low end of the totem pole in terms of getting resources, fixing staffing issues and purchasing educational pamphlets and journals carry out its program, because administration likely doesn’t see you as revenue-producing. I just had my journal budget cut for that reason.

But I’m confident my proposal will succeed because it delivers a one-two punch of evidence: There is a clear need and, by fulfilling that need, I can save the hospital tens of thousands through prevention.

Issue Date: Manager's Guide to Infection Prevention, 2006