Studies of return on investment from screening for Healthcare Associated Infections (HCAIs) have so far tended to focus on achieving a reduction in patient treatment costs. A handful of studies have also analyzed the direct impact of patient lawsuits resulting from HCAIs, but only in terms of the cost of damages and legal fees. Latest research, however, has found that, in the newly structured NHS, HCAI rates are likely to play an increasing role in the ability of a Trust to attract patients and the funds that come with them.
HCAI-related lawsuits are widely reported in the press, and therefore clearly affect a Trust’s reputation. Therefore, investment in methods and processes to rapidly detect and reduce HCAI rates produces valuable reputational returns that go beyond simply reducing treatment costs and avoiding damages. Being able to promote low HCAI rates may well influence the longer-term ability of a Trust to attract CCG funds.
According to a report published by the UK’s Health Protection Agency , rates of infection with the antibiotic-resistant ‘superbug’, MRSA, in British hospitals have fallen significantly in recent years. However, the same report warned that over 6% of English hospital patients still acquire some form of infection during their stay as new types of infections have emerged over the last five years. For example a class of organisms called enterobacteriaceae were frequently reported, with an almost 1% infection rate amongst the English hospital patients surveyed. Enterobacteriaceae include bacteria that are normally found in the human intestine, such as E. coli and salmonella, along with a range of newly identified strains. Of concern is the finding that around 15% of the enterobacteriaceae infections reported in the HPA survey appear to be resistant to some newer antibiotics too.
The success of the UK campaign to reduce MRSA infection rates clearly shows that HCAIs are to a significant extent preventable. The UK Department of Health advocates the adoption of “high-impact interventions” – evidence-based techniques to reduce the risk of HCAI such as hand-washing, use of protective clothing, regular and thorough cleaning of premises and equipment, rapid identification and isolation of patients with antibiotic or antimicrobial-resistant infections and a more appropriate and effective use of antibiotics through thorough screening.
However, any screening programme costs money – a real issue in an atmosphere where NHS spending remains under pressure.
The Rise of Reputational Risk and its Impact on Revenue
The Health and Social Care Act 2012 requires Clinical Commissioning Groups to ensure good practice, to promote and protect patient choice, and to improve services for patients. A hospital that is not seen to be striving to reduce HCAIs, or is showing a rate above that of peer institutions (especially those within a sensible travelling distance from the patient’s home) is likely to see reduced commissioning from CCGs over time. Sending patients to an acute care institution with a high HCAI count can hardly be seen as good practice for the CCGs and GP’s.
Lawsuits and Reputation
Studies into MRSA rates have found that lawsuit volumes follow the same trajectory as infection rate volumes. A reduction in the former entails shrinkage of the latter. ‘Superbug’ lawsuits gain a lot of media attention and therefore can be very damaging for hospital reputation. Moreover, the accumulated reporting over the last ten years may well have encouraged more HCAI victims to sue.
A recent report conducted fieldwork amongst a nationally representative sample of the populations in the UK, Germany, France, the Netherlands and the US, from September to December 2013. Most likely to sue following a serious HCAI were French patients, followed by those in Germany, and then the UK. Interestingly, in the US, propensity to sue is much lower than in the UK and Europe, possibly because state support for plaintiffs is less, and only a quarter of cases end up in the plaintiff’s favour  .
This recent research highlights that reputational and litigation risk actually form a significant part of the economic justification for further HCAI reduction initiatives in a newly competitive NHS.
 HPA, English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011: preliminary data
 U.S. Bureau of Justice, Medical Malpractice Trials, http://www.bjs.gov/index.cfm?ty=tp&tid=4511