System-wide practice initiatives are common in healthcare. For permanent change to take place, organizations are using sweeping innovations across their entire networks. Typically, these practice initiatives involve the utilization of new methods, new materials, and improved strategies to achieve the desired goal. Nevertheless, such large-scale motions are not without drawbacks. The generalized initiative coming from the very top often needs to be adapted to the local needs of the population.
Being able to detect the issues and working around them is an important part of succeeding in system-wide changes. The purpose of this paper is to analyze the issues and setbacks of a germ antibiotic resistance initiative at Kaiser Permanente.
About the Organization
Kaiser Permanente is considered to be one of the largest non-profit healthcare organizations in North America. It was founded in 1945 and provides healthcare insurance plans to over 12 million members (“Fast facts,” n.d.). The organization operates within the US and has its central headquarters in Oakland, California. The company owns 39 hospitals and over 690 medical offices around the country, with over 22,000 physicians, 58,000 nurses, and 150,000 auxiliary employees (“Fast facts,” n.d.).
The company is notorious for its progressive policies as well as a commitment to operational and medical excellence. Its largest offices are located in Northern and Southern California, Colorado, Georgia, Ohio, and Washington. The company’s operating revenue was at 72.7 billion dollars in 2017 (“Fast facts,” n.d.). Although it is stated to be a non-profit organization, its three branches, namely the Kaiser Foundation Hospitals, health plans, and medical groups, are all for-profit organizations that are reimbursed for their expenses from the central office. Kaiser Permanente has established a myriad of projects to help improve the efficiency of treatment and patient care.
Antibiotic Resistance Initiative
The medical community is increasingly concerned with the rising resistance of germs and bacteria to the standard antibiotic solutions used to sterilize tools, equipment, walls, floors, and rooms in hospitals. Hospital-acquired infections are growing in resilience due to having to survive in hostile environments with plenty of antibiotic solutions used. As a result, the surviving bacteria are much more likely to infect patients and suffer less from subsequent treatments.
The majority of the hospitals in the US utilize anti-bacterial paints containing triclosan and triclocarban (“Safer products,” n.d.”). These chemicals are contributing to the spreading of drug-resistant infections, with over 2 million cases per year happening in the US alone (Brown, 2018). Out of them, around 23,000 cases end in death.
The initiative undertaken by Kaiser is somewhat radical. By 2025, the hospital seeks to replace all paints, reagents, and instruments containing triclosan and triclocarban with more chemically and ecology-friendly solutions (Brown, 2018). As part of the program, the company had introduced a strict code of demands and regulations to its suppliers to ensure the safety of the clients and the reduction of antibiotic-resistant microorganisms in hospitals and primary care facilities.
Nevertheless, the initiative had encountered some problems. The main issue with this initiative is its cost-effectiveness. The main reason why the paints containing triclosan and triclocarban became so widespread in the hospital industry is that of their efficiency in the short and the medium-term perspective. These paints are efficient against unprepared germs, bacteria, and fungi, preventing them from growing on the walls and affecting the patients. Replacing the paint with the regular compound would not make the issue of infections go away. It would only make things worse, as the walls would need to be washed with a different kind of antibiotic on a much more frequent basis (Rodriguez-Mozaz et al., 2018).
As a result, the expenses for this innovation would invariably be carried over to the overall costs for treatment as well as the care plans sold to the customers. This was already evidenced by the fact that at the start of 2019 the costs for Kaiser have risen by 29% (Brown, 2018). There is no evidence to suggest that the company sought out alternative strategies to the dilemma, nor did it analyze the long-term effects on the communities as the result of rising prices.
The primary issues with the strategy are the increase in costs, which affected most customers in the low-tier bracket, and the long-term effects of the approach. The walls would still need to be covered with anti-microbial solutions, and the extensive use of a single antibiotic is likely to result in the creation of a different strain of antibiotic-resistant bacteria. Microorganisms can develop at an alarmingly high rate, resulting in a great number of mutations resistant to any particular drug.
Using different antibiotic solutions every time has a higher chance of success, though the long-term effects of such an approach would likely be less than impressive (Rodriguez-Mozaz et al., 2018). The proposed solution, thus, must combine the economic benefits of using antibiotic-laden paints with the announced course for reducing the number of antibiotic-resistant microorganisms in hospital settings. To do so, the active element in the paints must be changed every 3-4 years and be applied selectively, mostly in rooms and facilities most likely to encounter germs.
Antibiotic-resistant microorganisms are a danger to patients, resulting in prolonged hospital stay, increased morbidity, and even death. However, the appearance of such infections is the inevitable part of practicing sterilization in a long-term setting. Kaiser should weight the pros and cons of its strategy for the customers. Instead of following a general strategy to be implemented everywhere, the company should consider applying higher standards of antimicrobial sterilization only in places and facilities that truly deserve it.
Brown, M. (2018). Kaiser Permanente announces continued commitment to fighting antibiotic resistance. Web.
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Rodriguez-Mozaz, S., Chamorro, S., Marti, E., Huerta, B., Gros, M., Sànchez-Melsió, A., … Balcázar, J. L. (2015). Occurrence of antibiotics and antibiotic resistance genes in hospital and urban wastewaters and their impact on the receiving river. Water Research, 69, 234–242.
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