Government Grants Could Be Key to Reducing Healthcare-Associated Infections

Healthcare-related infections – illnesses contracted by people when treated in a hospital or other health care facility – affect millions of people each year and cost billions of dollars in additional treatments. According to the US Center for Disease Control and Prevention (CDC), about 3% of the hospitalized population in the United States has at least one healthcare-badociated infection.

However, these diseases have been difficult to prevent because hospitals located in a given area do not necessarily allocate the necessary resources for infection prevention. As a result, patients and health professionals – who can move freely from one facility to another – can spread infections from one hospital to another, even if some of these facilities are more alert than others in the fight against infections.

Researchers at Princeton University have proposed a plan for hospitals to receive a government subsidy corresponding to the dollar per dollar spent on infection control. Recently published in the journal Proceedings of the National Academy of Sciences (PNAS), the paper calls for targeting subsidies on hospitals located in a multi-hospital area with the lowest infection rates.

Co-author Ramanan Laxminarayan, principal investigator at the Princeton Environmental Institute (PEI) who studies antibiotic resistance, said that encouraging infection control would reduce infections in a region by encouraging hospitals to strengthen their own measures. preventive. These simple measures would reduce infection rates for the region as a whole.

"Coordination is the biggest hurdle when you have more than 6,000 health facilities in the country," Laxminarayan said. "With a grant, there is no need for coordination, we simply offer the grant to a set of institutions and we expect it to automatically change their incentives and behavior."

First author Sarah Drohan, Ph.D. candidate in the Princeton Applied Mathematics and Computer Science program, said that in areas with multiple hospitals, some institutions could potentially "take advantage of free" efforts and expenses invested by others.

Drohan and Laxminarayan collaborated with PEI co-authors and badociate professors, Simon Levin, Distinguished Professor of Ecology and Evolutionary Biology at the James S. McDonnell University of Princeton, and with Bryan Grenfell, Kathryn Briger and Professor of Ecology and Evolutionary Biology at Woodrow. Wilson School of Public and International Affairs.

"The behavior of free-riding is due to the fact that regardless of the choice of a hospital, the benefits are to some extent felt by everyone, not just by themselves," Drohan said. "But hospitals investing fewer resources in the fight against infections are releasing patients in a catchment area, and patients are not necessarily readmitted to the same hospital.

"Hospitals are spreading infections to each other across these shared patient communities," Drohan said.

An incentive to fight the infection would also help prevent dangerous bacteria from becoming immune to antibiotics, Laxminarayan said.

"Antibiotic resistance is primarily a common problem of environmental problems such as overfishing or climate change," said Laxminarayan. "We found that different hospitals in an area shared with other institutions currently have no incentive to invest heavily in the fight against infections, which would prevent the use of antibiotics. "

The current document stems from a PNAS article published in 2005 by Laxminarayan and Levin, one of the co-authors, who revealed that hospitals were not devoting as much resources to fighting infections in areas where they could likely benefit from the efforts of other institutions. The paper was followed by a number of empirical studies from hospitals that ultimately led the CDC in 2016 to seek regional control of infections rather than at the hospital level, Laxminarayan said.

In the new article, researchers used general data on infection rates in hospitals to develop a mathematical model to determine how prevention in two hospitals would change under different incentive systems. For example, a scenario imposed an "infection tax" that provided a fine for hospitals for each infected person, but the incidents of infection did not change. The researchers took into account the size of the hospital, the location, the financial resources and the population served, which had only a minimal influence, Drohan said.

Although researchers expect that co-operators will receive the most money to reduce the overall prevalence of infection, the model has surprisingly shown that all grant money should be allocated to stowaways, Drohan said.

Because these facilities would have a lower transmission rate due to the efforts of surrounding hospitals, the admission of infected patients has a proportionately larger impact, Drohan said. The model has shown that this disproportionate effect means that clandestine users have less incentive to invest in infection control without the subsidy.

"The indirect effect shown by the model is that the work of a health facility in the prevention of infections is directly rewarded and that other institutions are encouraged to spend more, especially those that do not." might not have spent as much before, "said Drohan.

"We have identified a workable policy that could save the health care system huge sums and prevent hundreds of thousands of people from falling needlessly sick," Laxminarayan said. "This could certainly be a bipartisan affair since no one favors more infections."

Drohan hopes that the work of his co-authors will lead to the collection of real-world experimental data on how hospital infection prevention policies evolve with the incentives and actions of surrounding institutions.