ANN ARBOR, MI--Did Medicare’s policy of withholding payment from non-federal hospitals for preventable nosocomial infections have the deserved effect? Not in every case, according to a new survey by the VA Ann Arbor Healthcare Center and the University of Michigan Health System.

Researchers found that while some 90% of U.S. hospitals surveyed increased efforts to prevent central line-associated bloodstream infections and ventilator-associated pneumonia between 2005 and 2009, practices to control catheter-associated urinary tract infections were much less commonly employed, according to the study in the Journal of General Internal Medicine.

"Despite being the most common healthcare-associated infection in the country, hospitals appear not to be using as many practices for prevention when compared with bloodstream infections and ventilator-associated pneumonia," pointed out senior author Sanjay Saint, M.D., M.P.H., director of the VA/UM Patient Safety Enhancement Program, and professor of internal medicine at the University of Michigan.

An estimated 5% to 10% of hospitalized patients get a hospital-acquired infection, and, in an effort to incentivize hospitals to do more to control them, Medicare stopped paying non-federal hospitals for the additional costs of treating such infections in 2008.

The CDC reported this fall that the numbers generally are moving in the right direction, with central line-associated bloodstream infections dropping by 33% and health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infection rates dropping by 18%. At the same time, catheter-associated urinary tract infection rates fell only by 7%.

"The actual impact of the no-payment rule appears limited given the fact that hospitals not affected by the rule change, such as VA hospitals, also increased their use of infection practices," said lead author Sarah L. Krein, PhD, RN., a VA research scientist and associate general medicine professor at Michigan.

Factors such as the introduction of practice guidelines and infection prevention collaboratives contributed as much, if not more, to the increased use of certain infection prevention practices than the Medicare rule, Krein added. Catheter-associated urinary tract infection is one of the no-payment conditions "but until recently there were no large-scale educational efforts or prevention guidelines created for this type of infection," she said.

Saint pointed out that using reminders to remove the catheter, cleaning the insertion site and using alternatives to indwelling devices can help hospitals reduce infection risk.

Adult surgery patients with postoperative catheter-associated urinary tract infection, overall and by selected comorbid conditions, 2006.

Source: Centers for Medicare & Medicaid Services, Medicare Patient Safety Monitoring System, 2006.

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