Infection Prevention That Pays Off: Making the Case for Universal Nasal Decolonization
Karen Hoffmann RN, MS, BSN, CIC, FAPIC, FSHEA
Connie Steed MSN, RN, CIC, FAPIC
Infection prevention and control programs are essential to patient safety, but too often they’re viewed as cost centers rather than strategic assets. How can healthcare systems reposition IP programs as value-generating initiatives?
In this Q&A, industry veterans and former APIC presidents Karen Hoffmann and Connie Steed bring over 80 years of combined experience to tackle this topic head-on. From CMS to corporate quality leadership, they’ve seen firsthand how infection prevention (IP) programs can influence organizational strategy, patient outcomes, and the bottom line. Their conversation highlights a high-impact strategy, universal nasal decolonization, and how a strong value proposition sets the stage for success when introducing new programs or technologies.
What is one of the biggest issues facing infection prevention and control today?
Karen Hoffmann: The biggest issue isn’t just clinical—it’s financial. Hospitals are under immense pressure to maintain their financial health, and unfortunately, infection prevention programs are often seen as cost centers. Why? Because we as Infection Prevention and Quality Leaders have struggled to connect our outcomes to the operational and financial goals that hospital leadership prioritizes, like throughput or revenue growth. We’ve measured infection rates and outcomes, but rarely have we translated our work into metrics like length of stay and increased capacity. If the CEO isn’t hearing about how IP reduces costs or increases capacity, we’re not demonstrating our full value.
How can quality leaders change the perception of IP initiatives?
Connie Steed: We have to speak the language of our senior leadership teams. That means building a value proposition—or what many would call a business case. Instead of just reporting infection data, we need to show how preventing infections reduces length of stay, opens up capacity, and improves reimbursement. Tools are available to help us do this. APIC offers a calculator that helps define the cost of treating infections, for example. By connecting our initiatives (e.g.: nasal decolonization) to operational and financial outcomes, we make our case in terms that resonate with leadership.
Why is universal nasal decolonization a compelling prevention strategy for building senior-level support?
Karen Hoffmann: Universal nasal decolonization checks all the boxes for a successful performance improvement initiative. First, it has a broad-based clinical impact, helping reduce CLABSIs, SSIs, and other HAIs. Second, it requires no capital equipment or additional FTEs. It has additional valuable benefits including patient safety. For example, reducing HAIs can lead to HAC, HRRP and value-based purchasing penalty reductions and can improve reputation with higher Leapfrog scores. Executives appreciate that it delivers measurable results without major resource strain. From a value perspective, it’s a standout.
Is there evidence of successful universal nasal decolonization programs?
Karen Hoffmann: Absolutely. A 300-bed Midwestern hospital implemented a nasal decolonization program across 65% of its beds. Using the value proposition approach we’ve described, they tracked outcomes over two years. They were able to admit 541 additional patients, leading to a $2 million increase in revenue. These results shifted the infection prevention discussion from a cost concern to a system-wide priority. When you show that kind of impact using executive-level metrics, leadership takes notice.
Can IP teams realistically execute on a universal nasal decolonization protocol with existing resources?
Connie Steed: Yes, and I’ve seen it work. When I was completing my master’s degree, I learned that every big decision comes down to operational and financial sense. A strong value proposition does three things:
- Aligns with organizational priorities
- Includes metrics that decision-makers care about
- Has a broad, measurable impact
Universal nasal decolonization is a great example with a great value proposition. It addresses multiple HAIs such as CLABSI, LabID bacteremia, SSIs. Many don’t realize that even if you’re not penalized, HAIs still cost the hospital money. Medicare often reimburses only half of what it costs to treat a HAI.
With the right framing and data, IP teams can implement a nasal decolonization protocol using tools they already have and demonstrate value. It’s a smart, strategic move that speaks directly to what leadership cares about most: safer care, improved efficiency, and better financial performance.
To learn more about this topic, listen to the podcast discussion between Connie Steed and Karen Hoffmann here.
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Karen Hoffmann and Connie Steed are consultants for Global Life Technologies Corp.