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Supply chain and infection preventionists team up

Although great strides are being made in many institutions across the country, it doesn’t mean that in all, or even most, instances resistant organisms can be knocked totally out of commission. Why isn’t it reasonable to believe that resistant organisms can be eradicated? Gina Pugliese, vice-president (based in Chicago, IL), Premier Safety Institute, Charlotte, NC, explained: "That would imply that a facility is a reservoir of resistant organisms that can be ‘cleaned out’ once and for all. The facility is treating patients who come in colonized or infected with resistant organisms or who, because they are on antibiotic treatment, may develop resistant organisms. There is a constant turnover of patients, and there may be changes in patient populations with different risks for infection; thus, different strategies may be needed to reduce infection. One size, one product, one device, or one service cannot fill all needs."

Traditionally the infection control department’s domain, the national mission of patient safety has led to a widening of the scope, so that the fight against resistant organisms is now a hospital-wide concern. The widened scope has resulted in teamwork between different departments. The infection control department working with the supply chain (SC) is a key development. That may sound odd at first, because there was a time when the SC was thought of mainly in connection with purchasing and inventory. Yes, they do that, but SC responsibilities, influence, and involvement go beyond that these days.

Joe Romano, writer for AdvanDx Inc., Woburn, MA, observed: "Infection control and SC personnel have largely existed in their own domains. The advent of increasingly resistant organisms spreading throughout the hospital necessitates a need for SC managers to team up with infection preventionists (IPs) to realize that a system-wide change must occur in the way both parties perceive how they can contribute to solving the problem and the way they work."

The Institute for Supply Management (ISM), Tempe, AZ, an international, not-for-profit membership, is the largest supply-management association in the world. Its mission is to lead supply management through its standards of excellence, research, promotional activities, education, and professional credentials. Michael Bohon, CPSM, CMRP, managing director, HealthCare Solutions Bureau, LLC, Show Low, AZ, is a consultant for, and member of, ISM. Bohon explained how the scope of SC professionals has expanded: "When meeting with and talking to SC professionals these days, it is evident that their world has expanded well beyond the narrow limits of just buying at the best price. In the 21st century, they must also be well informed on a large number of subjects outside what used to be their normal purview. These include not only information technology, lean management, and others, but very importantly the area of infection prevention and disease management."

Cindi Crosby, vice president, clinical operations management, Cardinal Health, Dublin, OH, also agreed that the SC is now taking on a larger, more active role in prevention and treatment of infection. "Supply-chain managers are in a position to balance the SC function with their hospital’s goals regarding safety, infection prevention, and patient outcomes. Hospitals are looking across their entire operations to control infection, including the supplies they use on patients. While cost is important, it is crucial that SC managers are involved in the preventive process. Many are already aware that the most common way of acquiring infections is through medical procedures involving urinary tract catheters, intravenous lines, surgical sites, and ventilators. Materials managers are taking a broader role in terms of infection surveillance."

Exactly why is it important for SC managers and infection control leaders to work together toward the goal of eradicating resistant organisms? According to Crosby, both parties bring valuable experience and expertise to the table, albeit from different perspectives. "It is very important that SC managers and IPs work together," insisted Crosby. "Many materials managers make it a point to include clinicians in product decisions that could have an impact on HAIs, and many see the how this expertise influences purchasing decisions, as does clinical evidence, value analysis, and best practice. The bulk of materials managers that we work with solicit clinician input when evaluating new products. The knowledge and expertise of both infection control and materials-management professionals is a vital asset."

Crosby outlined several ways that SC professionals can work with IPs to fight infections:

• Make ordering products that reduce infections a priority.

• Talk to clinicians to learn about products and their use with regard to infection control and general use.

• Study the facility’s infection control data and national guidelines to establish priorities, focusing on areas with the highest risk of infection.

• Contact manufacturers about opportunities to ensure correct product use and to involve the facility’s education team and infection control staff.

• Review use/purchase histories of products relative to infection prevention initiatives.

• Use electronic surveillance systems instead of manual surveillance to monitor HAIs.

A strong trend, noted Crosby, is bundling. "The Institute for Healthcare Improvement’s (IHI) 100,000 Lives and 5 Million Lives campaigns, the Surgical Care Improvement Project, and the Association for Professionals in Infection Control and Epidemiology’s Zero Tolerance Campaign have outlined evidence-based practices and procedures known as ‘bundles,’ aimed specifically at reducing HAIs and other unnecessary hospital events."

Bundles, explained Crosby, are defined as groups of scientifically validated processes for patients at risk. "The bundles emphasize certain practices that must be used consistently to reduce or prevent HAIs. Bundles vary, depending on the condition being addressed. There are bundles for prevention of surgical site, central-line catheter infections, and sepsis. According to IHI, bundling the steps together makes patient care a collaborative effort. Rather than acting independently, the doctors, nurses, therapists, pharmacists, and SC managers must work together."

Pugliese further explained the role of supply managers as they work with infection preventionists to put the kibosh on resistant organisms: "The SC manager may be part of a team that is developing the infection-prevention program that will include surveillance, education, training, protocols, products, services, clinical practices, and monitoring." Pugliese told Healthcare Purchasing News that this requires a complete assessment of a variety of the specific hospital characteristics, resources, services, and patient populations, including the following:

• Patient demographics (eg: age, risk factors, volumes)

• Historical infection surveillance data by type of infection, organism, patient populations, or units/departments

• Trends in antimicrobial-resistance patterns among organisms, patient populations, and departments/units

• Resources (eg, computers, data tools, staffing)

• Data on cost-effectiveness of products currently in use

• Focused and committed leaders

• Previously or existing successful initiatives or intervention teams led by the setting’s patient safety or performance improvement program (eg, bundles. Selection of these products requires an assessment of patient risk and scientific evidence from the literature on the efficacy of a product or process in reducing the risk, along with national guidelines.)

• Balancing cost with effectiveness.

Perhaps there was a time when locating the lowest cost for a product was the purchasing agent’s primary concern. Cost is always a concern; however, it’s becoming more and more apparent that, at least sometimes, costlier treatment may result not only in better outcome for the patient but better outcome for the facility’s pocketbook.

A case in point is the diagnosis of infection with a resistant organism. When a physician suspects an HAI, he or she may prescribe a broad-spectrum antibiotic to cover all pathogenic bases until a culture of the offending microorganism has had time to grow over the next few days. Once the pathogen has been identified, the physician then may select a more appropriate antibiotic for the situation. In the meantime, resources may have been used ineffectively or inappropriately, with both the patient and the budget suffering for it. A rapid diagnostic test, such as AdvanDx PNA FISH test, might actually save the facility money—by identifying the pathogen faster, so that the proper treatment can be prescribed initially, thus possibly contributing to a better patient outcome and reduced length of stay—even though the test may be more expensive than the traditional route. Romano said: "Rapid tests, such as PNA FISH from AdvanDx, provide early, critical information that enables the hospital to identify, treat, and save patient lives, while curbing resistant organisms and saving the budgets and material costs for SC managers."

Nevertheless, as Bohon observed, SC managers are under pressure to reduce costs at their organizations, and that often can be counterproductive to the goal of providing the best care for patients. "In today’s hospital," said Bohon, "there has to be a focus on the ‘best value’ of a product rather than the lowest cost. This is a principle easily agreed to by all, except when it comes to budget-review time." Bohon also noted that the biggest issue that must be overcome is achieving buy-in by executives that purchasing more costly supplies can result in a lower overall expense. "The ‘big picture’ should be the most important consideration," averred Bohon.

How can this be accomplished? Bohon outlined a series of necessary steps:

1. Ensure that a well thought out value analysis process is in place in your organization.

2. Develop an alliance between SC managers and IPs. Bohon noted that this can be difficult, because the IPs may assume that the SC is only interested in cutting costs; however, by working together, studies can be completed to determine what the total net effect the selection of a more expensive product may have, when taking into consideration other factors that may result in an actual reduction in the hospital’s operating cost.

3. Insist that a key executive be actively involved in the value analysis process. Running good, effective meetings with relevant information and measured results can help to ensure their involvement.

4. Build good reports illustrating both the cost-reduction successes of the SC and those issues dealt with that increased the total supply cost, with justifications for their approval.

5. Deliver these reports to the executive staff on a regular basis with the support of the IPs and other professionals.

A large part of teamwork between SC managers and infection preventionists involves evaluation of products’ effectiveness. This step is crucial and, without this supporting scientific evidence, it’s unlikely that administration could be persuaded that costlier infection-fighting products can sometimes save overall costs.

Pugliese noted the importance of understanding how to manage the process: "It will require education on how to evaluate antibacterial claims on products to distinguish them from data on reducing infections. Understanding the risk of infection for each type of product and its use or application requires teamwork and partnership between SC managers and IPs.

"In addition to evaluating the effectiveness of a product in reducing risk of infection, other considerations include product safety, cost-effectiveness, staff acceptance, availability, adult and pediatric sizes, user experiences, amount of training required to use, service or repair issues, and the environmental impact of the product or packaging."