Public/private partnership to address healthcare associated infections

In 2012, the Massachusetts Department of Public Health's (MDPH) annual acute care hospital HAI report demonstrated a nine percent increase in infections following vaginal hysterectomy (VHYS). The Massachusetts standardized infection ratio (2.14) was two times higher than expected and 73% higher than the national ratio (1.24). MDPH convened a workgroup of infection prevention professionals and surgeons from high and low performing hospitals to investigate the infections and develop improvement strategies. The VHYS workgroup developed a mission statement, defined the scope of work and piloted a series of survey and audit instruments. A 30-question survey was administered to surgeons who perform hysterectomies. To understand current surveillance, reporting, and prevention best practices, hospital infection control officers completed a similar survey. These officers received a self-audit tool to augment information about abdominal and vaginal hysterectomy procedures reported. Seventy-eight percent (47/60) of hospitals completed surveys. A preliminary analysis indicates 33% of hospitals report no policy for surgical vaginal preparation of patients undergoing vaginal hysterectomy procedures. Qualitative analysis of participant feedback indicates that engaging in audit-based chart reviews, in cross-facility cohorts, enhances hospital improvement efforts. Concurrent analyses of the surveys and audit tools will identify findings and recommendations by April 30, 2013. State health departments, which suffer from limited resources, diminished infrastructure and reduced workforce capacity, must collaborate with expert partners to solve emerging health problems. Driving proactive improvement instead of reactive regulation is challenging without sufficient support. This MDPH experience of leveraging partnerships is a practical and replicable approach for state health departments to address a variety of pressing public health issues.