Introduction The increasing problem of drug resistant bacteria has pushed health care providers to seek out alternative methods to reduce hospital-acquired infections. On the forefront of these alternative methods is the use of high intensity narrow spectrum lighting (HINS lighting) to inactivate harmful bacteria (Bach, Maclean, MacGregor, Anderson, Gettinby, Coia, & Tagger, 2012). This HINS lighting system works by using a narrow band of light, which is lethal to bacteria, but harmless to people. The light penetrates the microbes and excites the molecules inside, causing them to self-destruct. This ceiling mounted light provides continuous environmental disinfection (Bach et al., 2012). In the wake of the healthcare reform, an analysis of this new technology is important to providers, who stand to lose reimbursement payment for hospital-acquired conditions (Straube, B. & Blum, J. D. 2009). HINS lighting system may offer a way to escape financial loss while improving quality of care.
Background
In 2011 it was estimated that between five and ten percent of inpatients in the US acquire infections during their hospital stay, resulting in a cost of over 30 billion dollars (Haplin et al., 2011). CMS and other insurance programs have begun shifting this financial burden onto the providers in the form of reduced reimbursement for hospital-acquired conditions and mandatory reporting of infection rates (Straube & Blum, 2009). In addition to the financial pressure faced by providers, there is also pressure to deliver quality care. Providers want to maintain a profit, but also have a desire to provide the best care that can be achieved. The following sections will describe the benefits and limitations of the HINS lighting system.
The benefits of the HINS lighting system have been broken down into two aspects, monetary value and health quality. The monetary value will be addressed first. According to the article “The Policy on Paying For Treating Hospital-Acquired Conditions: CMS Officials Respond”, several insurance programs, including Medicare and many commercial insurers, have adopted policies which reduce reimbursement for hospital-acquired conditions (Straube & Blum, 2009). Under this policy, CMS will only reimburse hospitals for the care provided for the primary diagnostic group (DRG) and will not pay additional fees for potentially preventable conditions (Straube & Blum, 2009). This essentially shifts the cost from the insurers to the providers, so it is now in the best interest of the provider to take action against these nosocomial infections.
A 2005 study looking at the impact of hospital-acquired infections on medical cost showed that patients with hospital-acquired infections had an extra cost of $5335 compared to their matched controls (Sheng, Wang, Lu, Chie, Chen, & Change, 2005). Under the new policy, this cost will be put on the providers (Straube & Blum, 2009). This risk for financial loss may be avoided with the implementation of the HINS lighting system.
The HINS lighting system has the potential to decrease this financial loss by providing a continuous environmental decontamination. HINS lighting is an indiscriminate germicide, which means it is an effective killer of gram positive and gram negative bacteria as well as all drug resistant bacteria. Once installed in the patient’s room, it will cut down the number of hospital born infections (Maclean et al., 2010). A clinical study was performed which looked at the efficacy of HINS lighting to reduce the level of bacteria found in both outpatient and inpatient settings. The results showed that it reduced the level of bacteria well above what is achieved by standard cleaning (Bach et a.l, 2012). The actual figures showed reductions of MRSA by up to 86% , when compared to traditional cleaning methods. Along with this, there have been rigorous studies carried out assessing its safety that have shown that the levels used in hospitals are well below the threshold limit for any adverse effects to people(Bach et al., 2012). The adoption of the HINS lighting system is simple. It requires no staff training or even staff compliance. This system is wired to the normal light switch, and disinfection is as easy as turning on the switch (Bache et al., 2012). In addition to the reducing reimbursement for nosocomial infections, there are also policies which require mandatory reporting of hospital-acquired infection rates (Haplin, Milstein, Shortell, Vanneman, & Rosenberg, 2011). In an attempt to improve patient safety, many states are adopting policies which require hospitals to publicly report their infection rates. According to Haplin et al. (2011), “The idea behind mandatory public reporting is to give the consumers information about their risk of acquiring different types of infections – many of which are preventable- as inpatients of specific hospitals” (p. 724). This is another opportunity for financial loss to providers through patients choosing not to visit the hospitals with higher infection rates. Again, the HINS lighting system has the potential to help reduce the provider’s financial loss by keeping the infection rates low. Along with the financial benefits of the HINS lighting system is the elements regarding how it can improve the quality of patient care delivery. A study was performed in a burn unit (which has very high nosocomial infection rates) to see if the HINS lights would decrease the patients risk of becoming infected by a hospital bug (Bache et al., 2012). The results suggested that the HINS lights can make a significant contribution to increasing the quality of care delivered (Bach et al., 2012). In terms of improving the quality of care delivered, interventions in the past have been shown to be effective. An example of this was shown through the neonatal units banning nurses from having false fingernails. After the intervention, the hospital-acquired infection rate in newborns decreased significantly (Moolenaar, Crutcher, San Joaquin, Sewell, Hutwager…Jarvis, 2000). This is fairly straightforward; better quality of care can be achieved when your patients are not getting infected from the environment you use to treat them. A major limitation of HINS light is that it is not designed to replace standard cleaning, but rather be coupled with it. It must be left on for an extended period of time to be able to kill densely populated bacteria. This could become a problem because health care workers may rely too heavily on the HINS and slack off on their routine cleaning (Bache et al., 2012).
Discussion
Although it initially appears that providers would benefit financially from keeping patients longer under the fee-for-service payment method, CMS and other payers are attempting to transform this system into a pay for performance system as they augment policies and regulations (Straube & Blum, 2009). In response to this, providers should invest in HINS lighting to reduce hospital acquired infections, which will help them financially and assist them in delivering a higher quality of care (Bache et al., 2012).
The limitations of this analysis include lack of information regarding the price of instillation of a HINS lighting system. I searched everywhere I could think of and could not find a price.
Conclusion
The HINS lighting system is effective in killing hospital-borne pathogens, and should be adopted by providers. This system will provide financial benefits as well as improve the delivery of care. I recommend providers contact the HINS manufactures and negotiate a price for installation. I am sure it will be well worth it.
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