Is Zero an Empty Target?

It’s hard for anyone to say that any amount of healthcare-acquired infections (HAIs) greater than zero is good enough. And yet the reality is that because many treatments involve high levels of immunosuppression or bypassing natural barriers to infection, complete elimination of HAIs is virtually impossible.  

So are “Getting To Zero” programs misleading to patients and endlessly frustrating to hospital personnel, or do they inspire facilities to strive for constant improvement in their infection rates? The discussion at “Controversies in Hospital Infection Prevention” spurred us to think about this topic.

Clearly, increased awareness and standardized procedures have yielded significant improvements in infection rates for central line associated bloodstream infections, ventilator-associated pneumonia, and others. Checklists, greater compliance with hand washing protocols, improved environmental maintenance (hard-surface cleaning) procedures have all contributed to improvements as well. Common among those successes is collaborative effort.

Apocryphally at least, some “Getting To Zero” campaigns have been supplemented with incentives and penalties. It seem to us that tying such motivational factors to an unattainable goal will more likely result in declining morale than increased patient safety.

However, zero infections is still the right goal.  As one commenter said, “What else are you going to use? 10% reduction?” No healthcare worker wants to consider even one death acceptable, let alone almost 100,000 per year. Therefore, striving for total elimination may be motivational. While zero may be unattainable, improvements with continued attention to and compliance with infection control protocols are possible. Every patient saved from an HAI makes that improvement effort worthwhile.

Even though the target of zero HAIs remains elusive in the real world, striving for anything less is unacceptable. So as an aspirational goal, zero is useful; as a mandate or reason for blame, zero is, well, empty.