Healthcare Associated Infection Prevention: Safe Practice Update

1. Healthcare Associated Infection Prevention:Safe Practice Update L. Hayley Burgess, Pharm.D., BCPP Director, Performance Improvement TMIT March 26, 2008

2. Healthcare Associated Infection Prevention:Safe Practice Update Objectives: • Discuss potential updates to safe practices targeted to prevent healthcare associated infections. • Describe new HAI safe practices for consideration.

3. Healthcare Associated Infection Prevention • Preventing HAIs is a national priority • CDC estimates 1 of every 10-20 patients develops an HAI • Increasing incidence and morbidity • Evidenced based care works! • Financial implications for these complications

4. CMS Hospital Acquired Conditions and Present on Admission Indicator: No outcome, No income • Payment implications October 1, 2008 • Catheter Associated Urinary Tract Infection • Vascular Catheter Associated Infection • Surgical Site Infection – Mediastinitis after Coronary Artery Bypass Graft (CABG) Surgery • Considerations for FY2009 • Ventilator Associated Pneumonia • Staph aureus Septicemia • Further analysis • Methicillin-resistant Staphylococcus aureus (MRSA) • Clostridium difficileAssociated Disease (CDAD)

5. Culture 2007 NQF Report Culture SP 1 • CHAPTER 2: Creating and Sustaining a Culture of Patient Safety • Leadership Structures & Systems • Culture Measurement, Feedback, and Interventions • Teamwork Training and Team Interventions • Identification and Mitigation of Risks and Hazards Team Training & Team Interv. ID Mitigation Risk & Hazards Structures & Systems Culture Meas., F.B., & Interv. CHAPTER 1: Background • Summary, and Set of Safe Practices Consent & Disclosure Consent & Disclosure • CHAPTER 3: Informed Consent & Disclosure • Informed Consent • Life-Sustaining Treatment • Disclosure Disclosure Informed Consent Life-Sustaining Treatment Workforce CHAPTERS 2-8 : Practices By Subject • CHAPTER 4: Workforce • Nursing Workforce • Direct Caregivers • ICU Care • CHAPTER 7: Healthcare-Associated Infections • Prevention of Aspiration and Ventilator-Associated Pneumonia • Central Venous Catheter-Related Blood Stream Infection Prevention • Surgical-Site Infection Prevention • Hand Hygiene • Influenza Prevention Nursing Workforce Direct Caregivers ICU Care • CHAPTER 5: Information Management & Continuity of Care • Critical Care Information • Order Read-back • Labeling Studies • Discharge Systems • Safe Adoption of Integrated Clinical Systems including CPOE • Abbreviations Information Management & Continuity of Care Critical Care Info. Order Read-back Labeling Studies Discharge System CPOE Abbreviations Medication Management • CHAPTER 6: Medication Management • Medication Reconciliation • Pharmacist Role • Standardized Medication Labeling & Packaging • High-Alert Medications • Unit-Dose Medications Med. Recon. Pharmacist Central Role High-Alert Meds. Std. Med. Labeling & Pkg. Unit-Dose Medications • CHAPTER 7: Healthcare-Associated Infections • Prevention of Aspiration and Ventilator-Associated Pneumonia • Central Venous Catheter-Related Blood Stream Infection Prevention • Surgical-Site Infection Prevention • Hand Hygiene • Influenza Prevention Healthcare-Associated Infections Asp. + VAP Prevention Hand Hygiene Influenza Prevention Central V. Cath. BSI Prevention Sx-Site Inf. Prevention • CHAPTER 8: Condition- & Site-Specific Practices • Evidence-Based Referrals • Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention • Perioperative Myocardial Infarct/Ischemia Prevention • Pressure Ulcer Prevention • DVT/VTE Prevention • Anticoagulation Therapy • Contrast Media-Induced Renal Failure Prevention Condition- & Site-Specific Practices Evidence- Based Ref. Anticoag. Therapy DVT/VTE Prevention Press. Ulcer Prevention Wrong-site Sx Prevention Periop. MI Prevention Contrast Media Use

6. SP 19: Risk of Aspiration and VAP Prevention

7. Prevent Aspiration and VAP

8. SP 20: Central Venous Catheter Blood Stream Infection Prevention

9. SP 21: Surgical-Site Infection

10. Prevent Surgical Site Infections

11. SP 22: Hand Hygiene

12. SP 23: Influenza Protection

13. Influenza Prevention

14. Category 2 evidence: Encourage category II level of evidence: Obtain a signed declination from HCP who decline influenza vaccination for reasons other than medical contraindications (category II). Use the level of HCP influenza vaccination coverage as one measure of a patient safety quality program (category II). 2006- CDC Immunization advisory committee updated guidelines of HCW • Category 1 evidence: • Educate HCP regarding the benefits of influenza vaccination and the potential health consequences of influenza illness for themselves and their patients, the epidemiology and modes of transmission, diagnosis, treatment, and nonvaccine infection control strategies, in accordance with their level of responsibility in preventing health-care--associated influenza (category IB). • Offer influenza vaccine annually to all eligible HCP to protect staff, patients, and family members and to decrease HCP absenteeism. Use of either available vaccine (inactivated and live, attenuated influenza vaccine [LAIV]) is recommended for eligible persons. During periods when inactivated vaccine is in short supply, use of LAIV is especially encouraged when feasible for eligible HCP (category IA). • Provide influenza vaccination to HCP at the work site and at no cost as one component of employee health programs. Use strategies that have been demonstrated to increase influenza vaccine acceptance, including vaccination clinics, mobile carts, vaccination access during all work shifts, and modeling and support by institutional leaders (category IB). • Monitor HCP influenza vaccination coverage and declination at regular intervals during influenza season and provide feedback of ward-, unit-, and specialty-specific rates to staff and administration (category IB).

15. New HAI Practices for Consideration

16. Multi-Drug Resistant Organisms

17. Catheter Associated Urinary Tract Infection Prevention

18. Summary • Create embedded evidence-based processes of care • National commitment to improving outcomes by preventing healthcare associated infections • Accountability (public reporting and pay-for-performance) is here to stay