Challenging healthcare-associated infections: a review of healthcare quality management issues

Abstract Healthcare-associated infections (HAIs) are now a worldwide problem with devastating effects, both in economic and public health impacts in the medium and long term. In reality, this healthcare management problem became frightening when we became aware of large number of cases associated with this type of infection, especially the infections caused by agents for which the existing treatment no longer works effectively. This is the case of infections associated with healthcare caused by multi-resistant microorganisms, whose line of action in therapeutic terms may be exhausted. Several factors of growth have been identified, among which are the overuse of antibiotics (by direct intake or through food), environmental conditions, and the evolution of microorganisms. This means that, all over the world, rates of high prevalence and incidence for diseases caused by HAIs agents are now new contributions to rates of mortality and morbidity. Yet, already in 1959 a report on hospital infections by Staphylococcus, published by the Central Health Services UK, identified the prevalence of Staphylococcus as a major concern. Since then, this type of infection continued to occur, in spite of a growing understanding of the necessary measures for their control. It is known that, currently, the percentage of methicillin-resistant Staphylococcus aureus (MRSA) existing in the bacterial population of S. aureus associated with HAIs varies between 1% (Netherlands and Finland) and 44% (UK and Greece). However, regardless of advances in infection control systems, the incidence of HAIs remained relatively unchanged in the last 20 years (about 10%). The situation does not get better when we analyse the problem from the cost perspective. At this point, it is known that there is a direct impact in the hospitalization costs, in diagnostics (tests, examinations, etc.), and in treatments (antibiotics, surgery, and others). A 1992 CDC study estimated costs of HAIs and already suggested that the cost of infection control programs was approximately 6% of the total costs of the infections. In a 2003 report by the United Kingdom (UK) Department of Health, entitled ‘Winning Ways: Working together to Reduce HAIs in England’, it was estimated that the cost associated with HAIs per patient bed for a year was identical to the cost of an infection control program applied to a hospital with 250 beds. On what concerns quality management system, costs with HAIs may be comprised as non-quality costs. In this sense, an estimate by the Juran Institutes, suggests that non-quality costs can be approximately one-third of direct healthcare costs, and according to Nordgren et al. inflation of related costs is, in part, due to the increased length of stay and associated increased costs with providing the extra implicit care. This article explores these issues.