Mobile Integrated Healthcare

Reviewing the Need for Infection Control in Mobile Integrated Healthcare at EMS World Expo 2016

It was in 1978 that a search of the literature revealed that there were no infection control policies or procedures for emergency response systems. Infection control policies and procedures have now become an important element of protection for care providers and patients across the country.

In recent years, emergency care has been expanding into community paramedicine (CP) and mobile integrated health (MIH) delivery. The primary focus initially has been meeting needs of persons in rural areas and those with limited access to healthcare. This offers a significant change in practices from emergent care procedures to home care delivery procedures.

There has been a great deal of training focused on the delivery of emergent care, but infection control has not been addressed sufficiently. The transition to home care and the tasks performed in that setting are very different. These differences must be addressed in the infection control components of CP and MIH policies and procedures. This is important not only for the quality of care provided, but to assist in prevention of healthcare-associated infections. Note the term is healthcare associated, not hospital associated. The term has been broadened and EMS now comes under the wider definition as a clear part of the healthcare team.

In 2009, the federal government sent letters to all medical facilities in the country stating that there would be no federal money paid for healthcare-associated infections. A new, stronger focus on infection control practices followed to reduce infection rates in the healthcare setting. Now, in addition to not reimbursing for healthcare-associated infections, medical facilities are receiving a 3% reduction in reimbursement for frequent readmissions.

A healthcare-associated infection is one that occurs in a patient two days after admission or 30 days after discharge. EMS can have an impact on both time-frames, especially in the practice of CP and MIH.

A recent search of the literature in 2016 revealed no data on polices or procedures on infection control for the practice of CP or MIH. Procedures for the practice of home care infection control are very different from those of emergent care. For example, in emergent care an IV may be started on a patient who is then delivered to a medical facility where IV line and site are cared for using infection control practices. How would an IV site be cared for in the home health situation? Signs of infection need to be observed, and noted on a patient’s medical record. Do you know how to properly position a urinary (foley) catheter so that there is proper drainage and the patient does not develop a urinary tract infection that may result in hospital readmission? If a patient requires surgical site wound care post discharge, what is involved in using aseptic technique to prevent the wound from becoming infected?

If infection is noted and recorded on the patient record, did you know that the medical facility needs to be notified if this is within 30 days of discharge? Do you have a process in place for this notification and that of the attending physician?

A 3% reduction in reimbursement may not seem so big, but in the overall costs it is significant. Here are some of the costs that the Centers for Disease Control and Prevention (CDC) have projected:

  • Line infection: $19,427 per patient
  • Wound infection: $34,000 per patient
  • Ventilator-associated pneumonia: $28,508
  • Average healthcare-associated infection: $25,903

These are just a few of the differences between emergent care and home care that were presented at the EMS World Expo in New Orleans by Katherine West. West has also developed a handbook for infection control policies and procedures for CP and MIH services.