Our study showed that concerted infection control campaigns among a regional group of hospitals can yield substantial indirect benefits for hospitals involved and for hospitals not involved in the campaign. What’s more, the synergistic effects of persuading other hospitals in the same county to implement control mechanisms can help individual hospitals achieve better MRSA control than they can on their own. The more hospitals that work together, the more benefits accrue; doubling the number of hospitals that adopt the intervention can more than double the improvement in infection control.
These synergistic effects arise from the fact that hospitals often share patients throughout a county. Even when one hospital enforces strict infection control policies, its patients can be infected by MRSA-colonized patients from other hospitals that have less stringent infection control policies.
In fact, for some hospitals, having other hospitals implement some degree of MRSA control may be as effective or even more effective than improving procedures in a single hospital. Although our study explored the possibility of all hospitals’ using surveillance and contact isolation, our general finding would hold even if hospitals used different infection control procedures, as long as the procedures reduced the prevalence of MRSA colonization.
There has been some effort to stimulate cooperation among hospitals in controlling MRSA and other hospital-acquired infections. Statewide approaches and interventions to reduce hospital-acquired infections have been successful in Iowa; Pennsylvania; Michigan; New York; Wisconsin; and the Siouxland region of Iowa, Nebraska, and South Dakota.22–27
In the Siouxland region, the implementation of surveillance cultures and isolation led to a reduction in infections from another bacterium, vancomycin-resistant Enterococcus
Other collaborative efforts, such as the Iowa Healthcare Collaborative, have had success from several initiatives. A majority (93 percent) of Iowa’s hospitals implemented the MRSA control measures recommended by the 5 Million Lives Campaign of the Institute for Healthcare Improvement to some degree.27
Although it encountered implementation problems, the Pittsburgh Regional Health Initiative has created a culture of change to improve overall patient safety by providing opportunities to learn, increasing general awareness, and identifying common problems and solutions.28
These initiatives show the willingness of multiple hospitals to work together toward a common goal and to achieve an overall reduction in disease burden. However, to our knowledge, there has not been an evaluation of potential synergistic effects of facility interventions in a region.
In recent years, a number of collaborative initiatives have evolved.29
For example, in California the Safety Net Initiative, with a grant from the Blue Shield of California Foundation, is building a learning collaborative among public hospitals to reduce hospital-acquired infections—specifically, central-line infections and sepsis.
The Health Services Advisory Group of California, in collaboration with the Hospital Association of Southern California, has launched a Centers for Medicare and Medicaid Services Learning and Action Network to improve the quality of care. A major component is the Reducing Healthcare-Associated Infections Project. Its emphasis is preventing catheter-associated urinary tract infections, Clostridium difficile infections, and surgical site infections.
The California Healthcare-Associated Infection Prevention Initiative is another similar collaborative. The primary motivation for these collaboratives has been to share knowledge and best practices rather than to closely coordinate infection control measures.
To date, few studies have demonstrated and quantified the synergistic effects of hospitals within a large region coordinating infection control measures to achieve greater gains than they could achieve individually. Understanding these added benefits could provide extra motivation to hospitals to work more closely together. Computational modeling and simulation can be a useful tool for understanding infection control, especially at a regional level. Forecasting the effects of policies before enacting them can save valuable time and resources.
To that end, our study aimed to demonstrate the benefits of cooperation for each hospital, which may motivate hospitals to overcome barriers to cooperation. These obstacles are real. Hospitals have different budgets, resources, leadership, and competing priorities.30
Enforcing the same infection control procedures may be easier in some hospitals and more challenging in others.31
Information systems, reporting measures, and organizational structures may also be quite disparate.
It is also possible that as Medicare and other insurers continue to reduce reimbursements to hospitals with health care–associated infections, a hospital could use the achievement of infection rates that are lower than its competitors as a selling point to patients, insurers, and potential partners. A hospital could then make successful infection control policies and interventions into potential competitive advantages that it would be loath to share with other hospitals.32,33
As in this study, modeling and simulation can help extend the data collected from retrospective and prospective studies and make the case for cooperation. Modeling and simulation can serve as virtual “policy laboratories” for public health officials, policy makers, hospital administrators, and other health care decision makers. Here, modeling enables us to quantify the indirect and added benefits attained from regional efforts of admission screening for MRSA and greater compliance with contact precautions.