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For years, hospitals penny-pinching on infection control has been an open secret. Whether Covid-19 will puncture that pre-pandemic complacency is an open question. But it’s long past time for every hospital to treat infection control as a priority, not as a profit center.

Even before Covid-19 appeared, tens of thousands of patients died each year from preventable infections acquired during treatment. The contagious nature of the coronavirus has vastly increased the number of those at risk, with health care workers themselves now routinely endangered.


“We have gone far too long with not making the proper investments,” warned Kevin Kavanagh, the physician founder of Health Watch USA, in a recent commentary in Infection Control Today. “I fear that, as a society, we may well have to pay the price for this neglect.”

Receiving care at a highly regarded facility won’t necessarily provide protection against health-care-associated infections. ProPublica examined five years of inspection reports from 55 major hospitals designated by the Centers for Disease Control and Prevention as in the “first tier” of treatment centers able to handle an infectious disease crisis. Journalists found infection-control failures and other problems at more than half of the facilities.

One barrier to effective prevention has been the disturbing demand by many hospitals for a “business case” for infection control. This mentality, while not universal, has been common enough that the professional society of hospital epidemiologists issued guidelines to aid its members in “justifying” their programs by showing they’re not a “cost center.” I’ve personally seen vendors and hospital staff members being asked to make exactly that kind of argument.


The question of how to prod hospitals to alter their infection-prevention parsimony even attracted the attention of a group of Princeton researchers who, writing in the Proceedings of the National Academy of Sciences, proposed a solution derived from “coupled mathematical models … in a game-theoretic framework.”

This, of course, begs the question of why so many hospitals need guidance more complex than, “First, do no harm.”

Starting immediately, hospitals need to reexamine their approaches to infection-control processes and people. New research, for instance, suggests that current calculations of adequate staffing by specialists in infection prevention, who now call themselves preventionists, may be based on a flawed model. On the process side, some integrated delivery systems have found that centralized surveillance software for infections can both reduce human error and free up preventionists to do rounds on the hospital floor rather than filling out reports in the office.

This software is increasingly sophisticated, applying artificial intelligence to a variety of health information inputs, such as laboratory data, patient vital signs, and even genomic information, to make diagnoses, track transmission within the hospital, and analyze responses to treatment and drug resistance. Perhaps as important to accelerating adoption, the systems are being promoted with the marketing clout of global corporate giants such as Philips, SAS and Wolters Kluwer.

Still, Sharon Ward-Fore, a microbiologist and consultant in the infection control field, told me that specialists in infection prevention remain stretched thin at many hospitals at a time when those institutions are reeling from the financial impact of Covid-19. Ward-Fore, like many of her colleagues, is skeptical that increased spending on infection control staff or technology is imminent.

“Don’t businesses look to cut things that don’t generate revenue?” she asked pointedly.

With no end in sight to the Covid-19 pandemic, it’s tempting to believe that the business case for an all-out effort for infection control that goes beyond filling the storage bins with personal protective equipment is a slam dunk. The mathematicians and MBAs will soon enough tell us whether that’s true.

But whatever evidence emerges from Excel spreadsheets, the nearly 2.4 million Americans who’ve already been infected with Covid-19 make it starkly clear that the ethical imperative for infection control in hospitals has never been more compelling.

Michael L. Millenson is a patient safety activist, researcher, consultant, and author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age” (University of Chicago Press).

  • I can say, that in every hospital and health-system I ever worked in taking care of patients, that Infection Control was NEVER considered a profit center. The ID physicians, ID Practitioners, ID Pharmacists, and Microbiologists, Nursing, as well as the Hospital Leadership and Board of Directors, in conjunction with the Medical Staff always worked to address any issues to track and trace infections, prevent infections and resistance to anti-infectives, while protecting employees, and offer the best care to our patients. We implemented, what people now call Antimicrobial Stewardship, 30+ years ago and if you look at resistance to anti-infectives today, they are less than most hospitals/health-systems in the benchmark groups. We knew every surgical wound infection and every person that touched the patient, as well as compliance to pre-op, intra-op, and post-op anti-infective use. Pharmacists would help dose anti-infectives based on kidney function, streamline and also adjust doses to maximize anti-infective concentration. Hand washing was a focus, especially being a teaching hospital and patients were instructed to ask clinicians to wash their hands, if they didn’t see them do it upon entering their room.

  • I really don’t understand how it is ethical to withhold the information from the patient that the reason the doctor is having a conversation about end of life care is that they were flagged by a computer algorithm. These people are not children that others have a right to decide which information is important to consider in such monumental decisions. Doctors do not have a right to withhold information because the conversation will take longer in their busy schedules. It is unethical to withhold that the algorithms were only 40% accurate in retrospection – less than a coin toss. Does anyone consider that without giving the patient all the information used to make the decision to have the discussion that they are slanting the outcome of the situation?

    • Sandra, It is not clear that your response really is informed by this article. I don’t see anything about having end of life or palliative discussion informed by algorithm or about withholding information from patients. This article seemed to me about using technology as one tool in infection control, and that this may also have some conflicts with for-profit business models.

      As a nurse, and with my family and friends, I encourage EVERYONE of any age or health status to have conversations with their families and health care providers about goals of care and what treatments they may or may not want. It can be awkward or upsetting or difficult. But it’s still important, and the more we practice talking about our wishes or talking with our loved ones or patients, the better we will get.

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