CMS's 2008 decision to deny additional reimbursement for treating certain healthcare-associated infections has resulted in a sharper focus on infection prevention, according to a national study.

The Harvard Pilgrim Health Care Institute and Harvard Medical School-led survey found 81% of head infection preventionists at 317 acute care hospitals say they've increased efforts to prevent HAIs targeted by the CMS policy, particularly catheter-associated urinary tract infections and central line-associated bloodstream infections.

A majority of respondents said they've increased surveillance, education and prevention efforts designed to stop these types of infections. The survey found 71% of infection preventionists reporting that frontline staff remove urinary catheters more quickly than before, with 50% saying the same in regard to central venous catheters.

The survey revealed some of the policy's unintended consequences as well, according to study authors. For example, 33% of infection preventionists polled said that their facilities must shift resources from infections not targeted by CMS to focus more on preventing those specified by the organization. In addition, one-fourth of respondents indicated that their hospitals subjected patients to unnecessary diagnostic testing upon admission in order to avoid possible financial penalties.

"The CMS policy of eliminating additional payment for certain HAIs appears to have had a positive impact on hospital infection prevention efforts, yet careful consideration of the potential for unintended consequences is warranted," according to the study authors. "As CMS expands the list of complications for which it will adjust payment and continues to modify its requirements for reporting, it is critical to ensure that policy changes lead to measureable improvements in patient outcomes while minimizing potential unintended consequences."

Mark McGraw

Nurse anesthetists in Kentucky can now deliver anesthesia on their own after the state opted out of the current federal physician supervision requirement.

Kentucky has become the 17th state to do so since CMS afforded the choice 10 years ago, reports the Kentucky Association of Nurse Anesthetists. The association cites a 2010 study appearing in the journal Health Affairs which found that opting out of the physician oversight requirement did not increase rates of patient deaths or anesthesia-related complications.

Kentucky Governor Steve Beshear says the move, made with input from the state's Cabinet for Health and Family Services and healthcare providers, is aimed at giving hospitals and ASCs more flexibility in the anesthesia providers they employ.

"In cases like this, where the federal requirement is an obstacle to some of the best options for delivery of high-quality health care, we're pleased to take this step to opt out," he says.

Mike Rust, FACHE, president and CEO of the Kentucky Hospital Association, and Debbie Barber, CRNA, MS, president of KANA, laud the governor's decision, believing the move will increase access to cost-effective anesthesia care for the state's surgical facilities, particularly those in rural and underserved areas.

Daniel Cook

The presence of latex in surgical supplies and the clinical environment can be a direct threat to your patients' and employees' health and safety, or even a dormant one since many authorities note that allergic reactions to the material can emerge over time, after prolonged exposure.

As a result, a Poughkeepsie, N.Y., surgical center decided to phase out the potential allergen, identifying each product that contained it and acquiring suitable alternatives.

"Now that we've converted, I can say with confidence that it's easier to be a latex-free surgical facility than not," says a manager at the facility. Find out why in her account of the center's 3-month effort to eliminate the allergic issue.

David Bernard

Are you clear on the Centers for Disease Control and Prevention's guidelines regarding single-dose and single-use vials? The CDC isn't convinced you are, which is why it reiterated its position last week that medications labeled as "single dose" or "single use" are to be used for 1 patient only. But are there exceptions to this rule? Cast your vote in this week's InstaPoll.

Last week we asked about the most challenging part of your job. The results, based on 364 responses: