Adult hospital readmissions are a major concern among medical centers. According to the Healthcare Cost and Utilization Project (HCUP):1
- There were 3.8 million adult hospital readmissions within 30 days
- The average readmission rate was 14% with an accompanying average cost of $15,200. Around 50% involved 20 different diagnoses, with septicemia and heart failure among the top five conditions
- There were also high readmission rates (greater than 20%) for blood and immune system diseases, digestive system diseases and complications of medical devices and procedures
What's driving this? Healthcare-associated infections (HAIs) are a major cause behind these alarming figures (HAIs are infections that were not present at admittance and did not develop until 48 hours after admission).2,3 For example, 50% of patients with severe sepsis readmit within six months of discharge.4
Common causes of healthcare-associated infections
Viral, bacterial and fungal pathogens cause HAIs.5 The most common types of healthcare-associated infections are:
- Clostridium difficile infections: Clostridium difficile, the most common healthcare-associated infection, causes violent diarrhea. Long-term nursing home or hospital stays, advanced age, comorbidities and frequent use of antibiotics are other commonly cited factors6
- Central-line-associated bloodstream infections (CLABSI): Placed in a large vein in the neck, arm, chest or groin (usually to provide nutrition), central lines can cause bloodstream infections when pathogens enter through the insertion site. This is the third-most-common cause of HAIs and the deadliest3
- Catheter-associated urinary tract infections (CAUTI): When a catheter enters the urinary tract to collect urine or during surgery to keep the bladder empty, pathogens may enter through improperly sterilized equipment or from the patient's perineum3
- Surgical site infections (SSIs): Pathogens on the patient or the surgical team can enter through the wound site3
- Ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia: Patients inhale air contaminated with pathogens such as Staphylococcus aureus. In combining with central-line bloodstream infections, it is also the third-most-common cause of HAIs3
Preventing hospital readmissions
If left unaddressed, healthcare-associated infections can lead to sepsis, the body's extreme reaction to infection, and even death.3 One in three patients who die in a hospital has sepsis, and sepsis survivors over the age of 65 are three times as likely to experience reduced cognitive abilities.7 In fact, sepsis is one of the leading causes of readmissions. Of every 100 Medicare patients readmitted to a hospital within 30 days of discharge, over 21% readmitted because of sepsis.8
Obviously, a better course of action is preventing healthcare-associated infections in the first place.
A great way to start is to check out the McKesson Readmissions Resource™, which offers robust clinical resources to help you address common disease states that can contribute to higher readmission rates, including sepsis.
Other ways to prevent sepsis readmissions
Frequent hand sanitizing: The most effective way to prevent pathogen transference is strict adherence to hand hygiene before and after:3
- Entering or leaving the facility and a patient's room
- Every interaction with a patient or something the patient has touched
- Eating or drinking
- Putting on or off personal protective equipment
- After handling waste, blood or bodily fluids
- After using the bathroom (cleanse again if you use the bathroom door handle)
If your hands become cracked or dry from frequent cleansing, apply hospital-approved lotion because such cracking can create openings for pathogens.3
Administer the correct antimicrobial agent. Overuse or improper use of broad-spectrum antibiotics can cause internal pathogen transmission, which may disturb the body's natural bacteria. Chemotherapy and malnutrition can also depress the immune system, leading to internal transfers. Choosing the proper antimicrobial, dose and duration minimizes pathogen spread and growth.3
Disinfect or dispose of all clothing after use. A recent study found that "HAI bacteria pathogens can persist for more than a month on hospital fabrics, and that their persistence can be enhanced by moisture."9
Use single-use equipment where possible. For example, using electrocardiogram (ECG) leads in cardiac care may result in cross-contamination, even if they're clean. Single-use leads reduce that risk.10 Another study found that sterile, single-use bronchoscopes reduced infection rates.11
Remove drains and catheters as soon as it's safe. This is especially true if the patient takes this medical equipment with them when they discharge from a facility. Home healthcare may not meet the proper standards of care.12
Avoid premature discharge. Sending a patient home only to readmit them later is not cost-effective.
Give proper discharge instructions to patients. Discuss infection symptoms to watch out for and when to call their physician. Talk about the importance of hand-washing by everyone who comes into contact with the wound and provide clean or sterile technique guidelines for dealing with dressings, tubing and other medical supplies.12 Also provide patients with discharge instructions they can give to their general physician.
Assess and identify post-discharge needs. Patients with chronic or severe disease or who need wound care may need additional help at home. Ask about the patients' support systems and advise on available home health services.13
Make it easy for staff to comply. Institute infection control training for all healthcare workers. Place sanitizing agents and personal protective equipment in easy-to-access places. Put up signs that explain proper procedures and remind staff about compliance.14
With planning and strict adherence to protocols, hospital readmissions can be radically reduced. To learn more about infection prevention best practices, check out our UPrevent™ infection prevention program. Our clinical resource team is here to help you achieve top results.
Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.
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