• Sarah L Krein, Christine P Kowalski, Timothy P Hofer, and Sanjay Saint.
• VA Ann Arbor Healthcare System, VA Ann Arbor Center for Clinical Management Research and the Hospital Outcomes Program of Excellence, Ann Arbor, MI, USA. skrein@umich.edu
• J Gen Intern Med. 2012 Jul 1; 27 (7): 773779773-9.

BackgroundHospital-acquired infection (HAI) is common, costly, and potentially lethal. Whether initiatives to reduce HAI--such as the Centers for Medicare and Medicaid Services (CMS) no payment rule--have increased the use of preventive practices is not known.ObjectiveTo examine the use of infection prevention practices by U.S. hospitals and trends in use between 2005 and 2009.Design, Setting, And ParticipantsSurveys of infection preventionists at non-federal general medical/surgical hospitals and Department of Veterans Affairs (VA) hospitals, which are not subject to the CMS no payment rule, in 2005 and 2009.Main MeasuresPercent of hospitals using practices to prevent central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI).Key ResultsSurvey response was approximately 70%. More than 1/2 of non-federal hospitals reported a moderate or large increase in CLABSI, VAP and CAUTI prevention as a facility priority due to the non-payment rule; over 60% of VA hospitals reported no change in priority. However, both non-federal and VA hospitals reported significant increases in use of most practices to prevent CLABSI, VAP and CAUTI from 2005 to 2009, with 90% or more using certain practices to prevent CLABSI and VAP in 2009. In contrast, only one CAUTI prevention practice was used by at least 50% of hospitals.ConclusionsSince 2005, use of key practices to prevent CLABSI, VAP and CAUTI has increased in non-federal and VA hospitals, suggesting that despite its perceived importance, the non-payment rule may not be the primary driver. Moreover, while 65% of non-federal hospitals reported a moderate or large increase in preventing CAUTI as a facility priority, prevention practice use remains low.

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