Bill Klaproth (Host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. And with me is Karen Hoffman, IPC consultant Global Life Technologies Corp, as we talk about improvement programs that drive major enhancements in patient safety, aligning with both operational and financial organizational priorities. Karen, welcome.

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Thank you, Bill. Happy to be here.

Host: You bet. So Karen, let's start off with this. Can you talk about the compelling issue that this podcast will address about nasal decolonization?

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Sure. I want to really focus on how to navigate a path to securing support for patient safety initiatives. Today's hospitals are in a real financial crunch. Really, I've never seen a more difficult financial environment for getting approvals for new performance improvement programs. So, getting approval for those large programs that make a meaningful impact on your hospitals' bottom line requires a program that has a broad impact and knowing how to translate those infection reduction metrics into operational and financial metrics.

Hospitals have paid tens, sometimes hundreds, of thousands of dollars in performance penalties to CMS each year. And many of these penalties were driven by avoidable HAIs and for infection-related readmissions. And in fact, an estimated 1.7 million patients get an avoidable infection and nearly a hundred thousand die as a result each year in the us And this despite ongoing heroic efforts of hospital staff guided by infection preventionist, and quality leaders. So, the key word here is avoidable, avoidable infections and readmissions that could have been prevented.

Host: So, the key word is avoidable. Got it. So as a nurse leader listening to this podcast, what is the key takeaway?

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Sure. Yeah. The key takeaway I think is looking at performance improvement programs that are be seen as driving major improvements in patient safety programs that align with those organizational priorities, both operational and financial.

For example, the simple infection prevention step of using universal nasal decolonization has been demonstrated to improve patient safety, reduce length of stay, improve throughput, improve ratings, and increase revenue with no capital expenses. So, these improvements do not necessarily increase staff workload And in fact by reducing excess length of stay, they can actually free up staff time to take care of additional patients.

Host: So, I'm wondering how can nasal decolonization have this kind of impact?

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Yeah, good question. So, the nose is a reservoir. It's a source of many of the most common pathogens for HAIs, including the two of the most common, which is MRSA and MSSA. And over the past 40 years, we have come to realize that decolonizing the nose is one of the most powerful things we can do to reduce HAIs.

Staph aureus nasal colonization is the number one or number two risk factor for CLABSIs and reportable MRSA, bacteremias, pneumonias and SSIs. And so, nasal decolonization of MRSA is a leading risk factor for readmissions as well.

Host: So, why not just screen high-risk patients and then decolonize those that are positive?

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Yeah, sure. So, studies and now we have many studies that have proven that decolonizing all the patients in a unit actually outperforms targeted screening and decolonizing by up to 44%. And today's general patient population is much higher acuity than in the past. Over 70% of central venous catheters are actually not in the ICU. Ninety percent of all patients have a peripheral line. So, targeting strategies are much less effective because they don't control transmission and screening, and every patient is just not practical. So, decolonizing every patient or using universal nasal decolonization actually makes really good clinical sense. It avoids infections and saves lives. So, really, why is it not the standard of care today?

Host: Well, that seems to make sense. And you said trying to target this really doesn't make sense. You mentioned that universal nasal decolonization of all patients is the best. Can you explain a little bit more about why That is?

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Yeah, sure. Because the studies show that the best way to decolonize is to decolonize every patient, and that's because transmission is the major contributor to HAIs. And because targeting actually misses many colonized patients up to 40%. So, over 30% of patients admitted are already colonized with Staph aureus, and many more have at least one HAI-resistant pathogen. And these patients then go on to contaminate their rooms and their caregivers quickly. Some studies show in less than a day, which poses a risk factor for every other patient.

Host: So, can you talk a little bit more about how to translate HAI reductions into metrics of operational value?

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Yeah. So, we know that it makes sense to protect all of our patients. But most IPs and quality leaders don't really think they can convince their leadership to adopt such a program, and that's because IPS are focused on reducing infections, especially infections that have to be reported. But most infection preventionists are not focused on operational and financial impacts that senior leadership manages against.

For example, six CLABSIs that don't happen, may not get attention. But if you reduce treatment costs by $240,000, reduce the hack penalty by $10,000, freeing up 45 extra patient day beds and 500 nurse hours. Now, that can be something that can be used to generate an additional $360,000 with no capital expense. And that will likely fare much better with your management.

Host: So, hospitals have so many demands on resources right now. How can nurse leaders position nasal decolonization as a priority then?

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Sure. Well, you know, infection prevention strategies like universal nasal decolonization programs can compete for organizational resources with other more fashionable organizational options, like more software and HI, but only if we capture their full potential and translate those clinical benefits into those metrics that leadership is managing against. These programs impact not only reportable HAIs, but also the unreimbursed, non-reimbursed HAIs that are associated.

Host: So, I'm just wondering about the success metrics of this. Are there any measurable successes, any unanticipated surprises or outcomes that you came across?

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Yeah. So for measurable successes, I can give you an example of one facility I recently worked with that they avoided over $2 million in HAI treatment cost while generating an additional 3.6 million with no increase in capacity of our labor. So, these hospitals found that a horizontal approach to protecting every patient with universal nasal decolonization actually worked best, and it eliminated the need to screen and isolate for MRSA IN other patients because they're decolonized on admission.

Host: That's really interesting. So obviously, you're finding success with this at really good work on this. I'm glad that you're bringing awareness of this to us. Is there anything else you want us to know about Global Life Technologies Corp.

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Sure. Yeah. I think one of the things is that you can often get your vendors to help with these programs. But, you know, improve patient safety Initiatives like Universal Nasal decolonization also translates into better Leapfrog and other scores. It reduces penalties and actually increases revenue. So as well as increased pride in the patient care team that's providing this care. And sometimes we can see that the simplest things are the ones that have the greatest impact.

Host: Absolutely. Karen, thank you so much for your time today. This has really been informative. Really good to understand this a little deeper. Yeah, so thank you for bringing this to our attention. We appreciate it.

Karen Hoffmann, RN, MS, BSN, CIC, FAPIC, FSHEA: Thank you, Bill, for the opportunity.

Bill Klaproth (Host): You betcha. Once again, that is Karen Hoffman. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you at aonl.org/nursing-leadership-podcast. This is Today in Nursing Leadership. Thanks for listening.