Infection Prevention Thoughts of the Day

Thoughts of the day. Start reading at the bottom (or not). Be careful out there.

I'm madder than a giraffe with a sore throat...

…over the CDC budget, which Eli blogged about last week. As their budget gets cut further and further, the CDC leans more heavily on the Prevention and Public Health Fund (“Prevention Fund”) to pay for core functions. The problem is that the Prevention Fund was originally designed to fund new initiatives, not to fill in for ill-advised core budget cuts. And since the fund was established as part of the Affordable Care Act, it has now become a political target (and was already cut drastically as part of the payroll tax cut extension and Medicare “doc fix” deal). If you require further evidence of the tenuous status of the Prevention Fund, know that it has been termed “an Obamacare slush fund” by the GOP (note to whoever came up with that genius terminology: you are a colossal ***).

Ezra Klein had a great post last month about why prevention funding is so vulnerable in the current climate. In it he quoted Rick Mayes from the University of Richmond, on the “prevention paradox”:

“If public health measures are effective, the problems they are aimed at are often solved or never even materialize, thereby making them virtually invisible.

Few individuals have personal interactions with or know what epidemiologists, health program coordinators, virology trainers, and outreach specialists do. When individuals are spared from a disease because the air in their office building is clean, it is not immediately clear whom to thank or if thanks are even necessary. As a consequence, public health professionals, programs, and policies are largely invisible to the public and taken for granted.”

I agree with this, but I think the issue is even larger, and more depressing. The statement above assumes that if people were just informed of the consequences of not supporting prevention efforts, they would act differently. I don’t think so. I’m hearing more political candidates question the basic social contract, the very assumption that government has a legitimate role in providing for the common good (and that we all have an obligation to pay for it). I encourage you to listen to this podcast, entitled, “What Kind of Country”, which details some trade-offs that local governments are making when money runs out and citizens are no longer interested in paying to provide for the common good. I was particularly struck by the story of individual citizens refusing a small tax increase to keep all the streetlights on in their town, but willing to pay $300 out of pocket to keep the lights near their own house burning.

The plight of hospital infection programs: Doing more with less

APIC today released a survey of nearly 2,000 infection control practitioners that was conducted in March 2009. The results are alarming and serve to corroborate what many of us have suspected--resources for hospital infection prevention programs are declining.

Importantly, 41% of those surveyed reported reductions in staffing of infection prevention programs. This has resulted in reduction of infection surveillance by 24% of programs, reduction of process auditing by 20%, decreased environmental and walking rounds by 42%, and decreased educational programs by 38%.

Over half of those surveyed reported that regulatory requirements and reporting mandates make it harder for them to focus on infection prevention. Perhaps The Joint Commission and other regulatory bodies should think more about the adverse unintended consequences of their ever increasing mandates.