On April 28-29, 2008, Extending the Cure convened a group of 30 healthcare professionals—practicing physicians, healthcare administrators, policy-makers, and academics— to discuss hospital infection control in the context of emerging antibiotic resistance.  Some key observations are summarized below:

• Without a strong, scientific evidence base to direct decision-making, hospitals often look to other institutions, payers, or regulatory agencies for guidance on infection control.  Unlike drugs or medical devices, the regulatory environment for infection control is one of prescriptive guidelines rather than strict approval or disapproval. 
• The leading approaches to infection control require behavior change—on the part of hospital management, on the part of the people who interact directly with patients, and in some cases, the patients themselves.  Behavior change can be more difficult to engineer than installing a techno-fix. 
• Where change has happened, support at the executive level is vital.  Because infection control is a hospital-wide concern, communication lines must be open from infection control professionals to the top (or near the top).
• Cost-effectiveness analyses must be sensitive to financial metrics that are most important to hospitals.  “Cost savings” may not resonate as much as reduced lengths of stay or improved revenues.  Expenditures within a hospital can be highly fragmented, making a cost savings argument challenging.
• Carrots versus sticks:  poor performance—e.g., as defined by CMS in their new regulations denying payment for preventable errors—can be punished financially, but we need to see what the effects (possibly unintended) might be.  Much may also be gained through positive incentives.  Rewarding hospitals financially for doing well is going to be more effective, and will be better for the population at large, than penalties.  
• Small hospitals face special challenges in implementing infection control, especially with regard to staffing resources, putting up costs to support front-end infection prevention, and institutional understanding of the role of infection control practitioners.
• Infections can be reduced:  evidence from the publicly-financed VA hospital system, at least one private U.S. hospital system (HCA), and from the United Kingdom and elsewhere in Europe is clear.  With appropriate policies in place, resources to support them, and the personnel to carry them out, infections can be reduced (and money is probably saved).