Infection Prevention remains the lock on the safety chain

July 22, 2022
Working with Supply Chain reinforces patient, staff, visitor protection

Forward-thinking healthcare administrators and management consultants routinely caution against working in silos because that can lead to departments running around in circles and a lack of trust due to unfamiliarity.

Instead, they encourage and recommend interdepartmental relationships for the benefit of the healthcare organization and the patients it serves. Call it a circle of trust between two or more areas or departments working together for the common good.

For Infection Prevention – both the department and function – such relationships extend to Sterile Processing and Distribution (SPD), Environmental Services and Surgical Services for logical reasons, and especially with Supply Chain. [Editor’s Note: For examples, visit https://www.hpnonline.com/infection-prevention/article/21213928/infection-prevention-and-spd-united-we-withstand and https://www.hpnonline.com/infection-prevention/article/21206385/managing-the-microscopic-battleground.]

Why does Infection Prevention (IP) partnering with Supply Chain make so much sense? IP has the clinical experience and expertise for product and service evaluations and value analysis; Supply Chain has contracting and negotiating expertise, as well as professional connections with suppliers, to procure and provide what’s needed for optimal costs.

At facilities where those bonds exist, the COVID-19 pandemic certainly stretched and tested their mettle.

“It is vital to our Value Analysis process to have our Infection Prevention nurses weighing in and participating in product standardization and savings initiatives,” insisted Cheryl Anderson, System Director of Value Analysis at Steward Health Care. “They bring a unique perspective at looking at product conversions and how changes could possibly jeopardize patient care and nursing safety. 

“Our Infection Prevention nurses were key in monitoring and managing products during the height of the pandemic,” Anderson continued. “They evaluated different N95 respirator masks that popped up in the marketplace and developed a procedure to re-use and preserve our N95 masks. They played a key role on Steward’s Emergency Preparedness Team.”

Critical value

Executives at HealthTrust recognize and understand the value of Infection Prevention partnering with Supply Chain.

“Collaboration between Infection Prevention and Supply Chain is critical,” indicated Jennel Lengle, Assistant Vice President of Clinical Operations at HealthTrust. “Supply Chain is constantly being lobbied by determined suppliers eager to get their products on contract. Many claim their products help to reduce Hospital-Acquired Infections (HAIs). Engaging IP experts in product vetting can leverage clinical evidence reviews and practice reviews and ultimately impact the overall quality of patient care. Their expertise can help sort through all details to determine what outcome claims are true and which are not supported by evidence. This type of collaboration brings value to the organization by improving clinical outcomes and safety, creating efficiencies, and finding savings.”

Suppliers acknowledge that inherent value, too, specifically as providers strive to implement product and service standardization efforts and enhance best practices, according to Donna Matocha, DNP, VA-BC, Manager Clinical Resources, Medline Industries.

“Our central line insertion and dressing chance bundles, included in our Vascular Access Health Solution to help prevent CLABSIs, incorporate best practice guidance, education and training, and a system of products to better support clinicians,” Matocha explained. “Before Medline’s clinical support team can provide a health system with a recommendation on bundles, we often initiate a clinical assessment to gather essential data. During an assessment, I have found that when there is participation from the system’s supply chain team in the leadership interview, the project’s scope is better understood, easing the anxiety of the potential increased product cost. Respecting the fact that the supply chain’s role is to control and reduce costs is paramount to the hospital’s financial viability. I worked with one customer in this way, and when it came time to present the assessment findings, by having the supply chain team in that meeting, the approval for the new bundle was granted in that same meeting. Adding that team to the conversation earlier provides them with all the facts.”

As an example, Matocha describes her experience working with a large system of hospitals with her main point of contact was a member of its clinical supply chain department.

“Our first introduction of the product portfolio to their system included her and the system Infection Preventionist, and we were able to get clinical validation and identify appropriate [stock-keeping units] within the same conversation,” she said. “Once ready to move through to trialing the product, the clinical supply chain contact will also be able to ensure we bring in the appropriate system clinical leads.”

Against the backdrop of the pandemic and the ensuing global supply chain challenges, Infection Prevention working closely with Supply Chain should be imperative and an ongoing reality to enable uninterrupted patient care, according to Sarah Herrmann, Director, Program Services, Vizient.

“Procedures and protocols on both sides must be continually evaluated to ensure supplies associated with infection prevention follow best practices, including strategies for sourcing, inventory, and communication between the supplier and the provider as needs change,” she said. “Stakeholders should align infection prevention, supply chain and product to create operational efficiency, thereby reducing or eliminating the threat of improper product use that creates unsafe conditions and contribute to wasteful inefficiencies.”

Herrmann emphasizes the strategic continuity between these disciplines will reinforce four tactics:

• The ability to obtain needed products for optimal patient care

• The ability to maintain patient and clinician safety

• The ability to ensure that infection risk is minimized by utilizing products with relevant Infection Preventions for the specific patient in their specific care setting

• The ability to operate efficiently in terms of delivery, quality and costs

She adds that any inability between the two departments to coordinate product acquisition may lead to “sub-optimal patient care outcomes, inefficient purchasing patterns and at times higher overall costs for the organization.”

Intertwining goals

Structured governance and aligned decision-making represent the core of HealthTrust’s sourcing and contracting process, according to Lengle. Advisory boards and specialty committees, comprising subject matter experts from member organizations as well as physician advisors, vet products and submit their recommendations to the Supply Chain Board.

The HealthTrust Infection Prevention Specialty Committee includes 26 members representing 18 health systems. These experts develop strategies and determine clinical efficacy across the portfolio that then are vetted by a primary board, such as the Nursing Advisory Board, and a specialty committee, such as Infection Prevention, to ensure multiple aspects of clinical utilization and clinical operations are considered, she adds.

“We strive to ensure that products have clinical efficacy across multiple patient-care areas,” Lengle said. One example involved infusion port disinfection caps.

“We discussed this category among several service lines to ensure it met all clinical and operational needs,” she noted. “The Infection Prevention Specialty Committee weighed in on the evidence behind the different device options and concluded that, based on research, all devices were clinically equivalent and met the needs of the represented IP programs, and therefore the membership. The Nursing Advisory Board also engaged the Perinatal Specialty Committee to review the products and strategy from a nursing practice and operational perspective. The feedback from these discussions was utilized during the negotiations to develop a strategy which brought savings to the membership.

“When evaluating products, it is imperative that clinical needs and outcomes are considered,” Lengle added. “Breaking down silos, collaborating and sharing feedback across service lines allows for better product adoption and ensures multiple aspects of utilization are considered.” 

While working at a hospital, Medline’s Matocha witnessed the push-and-pull between the two departments that must be addressed and resolved for progress to be made.

“I learned that Infection Prevention and Supply Chain teams have two distinct roles that are equally important and, by nature, can conflict with one another,” she said. “Both teams have to understand the driving factors behind making a change. Supply Chain may be looking for SKU reductions and cost savings, while IP/Quality/Nursing will want improved patient outcomes, reduced variability and standardized practice following evidence-based practice guidelines. Usually, if one team is far down a path in their decision-making process without including the other, we see that the less optimal options are often chosen. We see great success when the Value Analysis and Supply Chain teams have members with clinical backgrounds. Even removed from direct patient care for some time, those team members can evaluate products and bring in the appropriate decision-makers earlier.”

HealthTrust’s Lengle asserts that neither department should dominate the process because supply chain remains a “critical component” of infection prevention and vice versa. Supply Chain working in concert with clinicians helps to meet organizational goals and produce quality outcomes, including infection prevention, she says.

“Supply Chain enables clinical strategy to identify the best products to advance these organizational goals,” Lengle said. “Products are evidence-based and must be used according to the manufacturer’s Instructions for Use (IFUs). Once products have been identified, Supply Chain allows for infection prevention through standardization, reducing the need for end-user education and reducing infection risk overall. For example, by using multiple non-standard cleaning products in a single space, the dry time to reach effectiveness may vary, and therefore user-error related to surface sanitization is possible. By standardizing cleaning products, an organization can ensure consistent results regardless of the end-user environment.”

Supply Chain also plays a key role in product selection related to patient and staff safety, according to Lengle. “Hospitals must know they have the products necessary to protect staff while they are providing patient care,” she said. “An ongoing dialogue between Supply Chain and clinicians is critical to understanding disease peaks or plateaus, and therefore related consumptions needs. Robust communication between clinicians and Supply Chain also ensures quality control and efficient use of product shelf life. The COVID-19 pandemic underscored this tenfold.”