Greater role in product review boosts bottom line
NY program has hospitalwide impact
With budget cuts looming in an era of managed care, infection control professionals can justify their programs and show dramatic cost savings in the area of product evaluation, says Robert Garcia, MT, CIC, assistant director of infection control at Brookdale University Hospital & Medical Center in Brooklyn, NY .
"There's no question about it -- everybody is talking about cost reduction," he says. "Infection control deals with many issues, products and programs that really have an impact in terms of cost."
Under a program begun in 1993 at the hospital, the infection control department has an active role in systematically assessing products and programs throughout the hospital with an emphasis on reducing costs. The program includes a form developed by infection control that is now used hospitalwide to request new products. (See form, inserted in this issue.) Examples of items reviewed include surgical scrub brushes, lancets, disinfection solutions, gowns, masks, central lines, and surgical scrub suits. The form goes to the director of purchasing, who will discuss the item with the vendors and seek information on competitive products.
"When you get to the meeting you may be looking at maybe three or four products in that category, and you can make an intelligent, informed choice on what's available and what would be best," Garcia says.
Prior to implementation of the system, individual departments would submit requisitions for their products and infection control may have been unaware of what items were in use by various departments.
"That could even be a legal issue, a liability for us," Garcia tells Hospital Infection Control. "But now that everything is on the same standard, not only are we looking at safety but also cost effectiveness. Unless you standardize, you can't be sure that everybody is doing the same thing the same way or that the products have been reviewed for safety, effectiveness, and cost."
For example, he estimates savings of $57,000 over the last year by eliminating the purchase of disposable scrubs and going to color-coded reusable scrubs. In addition, standardizing the purchase of gowns -- reducing a wide variety of styles ordered by various departments to three styles from two vendors -- has saved an estimated $42,000 since May of 1994. Overall, Garcia projects some $844,000 in total hospital savings in the three-plus years the program has been in place. That message has been shared with administration, and thus far the infection control program has been spared budget cuts and reductions in staff, he says.
"Can that still happen? Sure it can," he says. "But this is something you can show administration -- showing them that within a team concept you are doing something real positive."
Once the process is completed and the committee agrees on the purchase of a new product, it is best to phase out the old stock as rapidly as possible to enact the transition, Garcia notes. (See tips, p. 115.) In that regard, he recommends consolidating the last inventory of the old product in one unit or area for use until stock is deleted. If worker safety is an issue, collecting the old product immediately may be considered, as was the case when Brookdale Hospital switched to a safety-designed lancet for fingersticks.
"We had people being injured by the old lancets that we used for fingersticks, so when we introduced a safety product, it was critical for us to get rid of the old product as quickly as possible," he says.
Another important consideration is whether vendors will conduct inservicing of new products to ease health care worker acceptance and ensure proper and safe use.
"We don't approve any product unless we know that the vendor is going to responsible for doing a housewide inservice," he says. "That could be -- if they have to -- floor-to-floor and shift-to-shift. We will sit in on at least the first inservice to assess it and give our opinion."
With front-line health care workers more likely to be motivated by patient and worker safety issues rather than cost savings for the hospital, it is best to highlight such features in trying to enact something that is always difficult -- change.
"Most of the time I find people are very receptive, but the bottom line is you have to force it upon them," he says. "That's one of the reasons I like to pull the old product as soon as possible. Because they'll accept it, but don't let it languish." *
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