This is important because the cost of hospital acquired infections run high. The cost to care for a patient with a hospital acquired infection is almost three times the amount to care for a patient without a hospital acquired infection (Hassan et al., 2010). Since hospital acquired infections can be attributed to the hospital, Medicare and Medicaid will no longer cover payment of these infections beginning in 2008. Medicare and Medicaid reimbursements are designed to set payment rates that are consistent with hospital costs (Malatestinic et al., 2003). An acquired hospital infection is not considered a cost to Medicare or Medicaid since the patient contracted the infection through no fault of his own, but while under the care of the hospital staff. Deutsch does not agree with this decision and states that Medicare and Medicaid are doing more harm to the patients by withholding hospital payments and instead should invest more money into the Agency for Healthcare Research and Quality so that hospital staff can be trained properly on the procedures to take to avoid hospital acquired infections (2008).

It is reasonable for Medicare and Medicaid not to feel they should reimburse for hospital acquired infections because cases such as these can be seen as hospital neglect. In some cases, when patients acquire the infections it is due to negligence on the part of the caregiver by not performing proper hand hygiene or not caring for and cleaning the catheter sight properly. However, even with the most stringent set of hospital procedures in place to reduce infections, even a small percentage of patients may be prone to acquiring them. No matter how the patient acquired the infection, he is still left out in the cold if Medicare or Medicaid refuses payment. This is not fair to the patients and this is the point that Deutsch is making. Other means should be sought out, such as proper education instead of the complete withdrawal of the payments.

One thing to consider regarding this Medicare and Medicaid reimbursement issue is that both will reimburse in the case of self neglect (Franzini and Dyer, 2008). This is when the patient does not (for whatever) reasons take care of himself. Sometimes mental illness can be involved preventing the patient to properly care for himself, but sometimes the neglect is willful. A patient can be mentally sound but does not take the medications prescribed to him, yet Medicare will reimburse for this.

In essence, what should be done is what Deutsch suggests. More funding should to go into educating hospital staff on the proper procedures to prevent hospital acquired infections. Educating the staff seems to be a more effective measure than withholding payments. The withholding of payments for hospital acquired infections has the potential to put the patient at a disadvantage unless the hospital takes ownership and covers the costs associated with the infection.

Medicaid reimbursements have a direct impact on nurse staffing levels, in particular at nursing homes. Harrington et al. (2007), found that Medicaid only nursing homes had fewer nursing staff with fewer nursing hours than for profit nursing homes. This is important not because it is an indication of the quality of nurses at the Medicaid only facilities, but these facilities have a tendency to be short staff because of the reduction of reimbursements could mean more patient neglect and a higher chance for hospital acquired infections.

Lately, there has been a reduction in the Medicare and Medicaid patients that Advance Practice Nurses (APN) as well as physicians will treat (Cunningham and O'Malley, 2008; Frakes and Evans, 2006). The whole issue of what Medicare and Medicaid will reimburse can be detrimental to their business, especially if it is a private practice. The last thing these professionals need is to have payments withheld because they are being blamed as the cause of a patient getting an infection.

Stone (2009), states the following, "This is a radical change in reimbursement, which may result in a variety of practice changes. The first and most positive is that hospitals react as CMS hopes and find ways to improve processes and decrease health care-associated infections. The second is that there is no real change in the infection rate; in this case, hospitals may lose the incremental revenues or just change coding practices. The third and least positive response is that the policy results in perverse incentives for hospitals to engage in processes that are not in the patients'...

17A).
IV. DESCRIPTION OF PROJECT

The objective of this project is to come up with a set of policies regarding the ordering, use, and healthcare maintenance for Foley catheters at the Jim Thorpe Rehab Center. Based on the information presented in the Literature Review, the program will be designed to be conceptual because there is an abundance of information on the topic, yet the information will be refined even more to suit the purposes of the project.

We have learned that a number of patients are allergic to the latex Foley catheters and that there has been an overall reduction in the incidents of catheter induced urinary tract infections by using the all silicone, silver coated catheters. The silver coated catheters are more expensive than the latex catheters, but in the long run they make up for this by reducing the costs associated with caring for the urinary tract infections. What the Jim Thorpe Rehab facility needs to do find the money in the budget or somehow make budget transfers so that the silver coated catheters can be purchased. They could also get bids from at least three vendors of the catheters. If they buy a certain amount, they should be able to negotiate a discount in order to buy more catheters to be safely used on the patients.

In addition to buying the silver coated catheters, doctors and nursing staff must determine if a catheter will even be necessary for the patient after surgery or other medical procedures. Many hospital and healthcare staff use the catheters without fully considering that there may be other options. The literature has shown that there are other alternatives to the catheter depending on the condition of the patient such as the superabsorbent diapers which are now made in sizes to fit most everyone from children to adults of all shapes, sizes and weights. If a patient is totally incapacitated, then the Foley may be necessary. If the person isn't 100% incapacitated, the superabsorbent diaper may be the best alternative as long as care is taken that the diaper is changed frequently.

Based on the literature, there are simple procedures that health care providers can do in order to improve the hygiene and reduce the transfer of infections to the patients. Because of the shortage of nurses and other healthcare professionals, many nurses find that the number of patients they must care for is overwhelming. In focusing on providing the best possible care for the patients, basic things such as the thorough washing of hands in between patient care is often forgotten. Studies have shown that because of this oversight, bacteria and infections are easily carried by the nurse or other healthcare professional from one patient to the next unknowingly. Two prevent this from happening, proper training should be mandatory.

The literature states that there is a hospital in Canada with an electronic monitoring system that encourages frequent hand washing. Because the system is electronic and would require constant maintenance, it would be easier for the Jim Thorpe Rehab facility to do something as simple as placing posters near the doors of each room that serve as a reminder for the nurse or other healthcare professional to wash their hands before caring for another patient. This would be one step to remind the staff and since human nature is sometimes very predictable, staff could have brief weekly meetings where the nurse in charge gives a gentle reminder and mail slots can be set up for personnel and a flyer reminding them of hand washing procedures could be placed in their mail slots on a regular basis.

Another issue regarding the catheters is the proper care and cleaning of them. Nurses and healthcare professionals should have ongoing training on the proper care of the catheters in order to prevent infection. Since Medicare and Medicaid will no longer pay for hospital-acquired infections, it is imperative that proper care be administered to eliminate any catheter induced urinary tract infections. These types of infections have a high morbidity rate as we have learned from the literature. Close to 100,000 patients per year die because of catheter induced urinary tract infections. Of all hospital acquired infections, the catheter induced urinary tract infections are at the top of the list and it is unfortunate because the majority of them can be prevented.

If a patient is lucky enough to withstand the infection, he still will need to take antibiotics and perhaps other…