Susan J. Rehm, M.D. Vice Chair Department of Infectious Disease

1. Susan J. Rehm, M.D. Vice Chair Department of Infectious Disease

2. The Cleveland Clinic

3. System Hospitals

4. Location, Location, Location

5. The Cleveland Clinic 40,00 employees Electronic medical record in use for outpatients; gradual implementation for inpatients Use of intranet makes sense-standardization of information, methods, data at diverse sites

6. Patient Safety/Infection Control Initiatives at The Cleveland Clinic Improving influenza vaccinations among health care workers Improving hand hygiene Reducing risk of surgical site infections Efficacy of decolonization of S. aureus nasal carriage prior to open heart surgery Improving antimicrobial use Penicillin skin testing

7. Outbreaks of influenza in hospitals have been linked to transmission from otherwise healthy healthcare personnel and are a major patient safety issue. The Advisory Committee on Immunization Practices (ACIP) recommends that healthcare personnel with patient care duties receive an annual influenza vaccine. However, vaccination rates among healthcare personnel are extremely poor; less than 40% of personnel are immunized in most facilities. * One or more high-risk medical conditions including diabetes, current cancer treatment, or chronic heart, lung, or kidney disease. ** Healthcare workers included persons currently employed in healthcare occupations, regardless of setting, and persons currently employed in healthcare settings without a healthcare occupation. Outbreaks of influenza in hospitals have been linked to transmission from otherwise healthy healthcare personnel and are a major patient safety issue. The Advisory Committee on Immunization Practices (ACIP) recommends that healthcare personnel with patient care duties receive an annual influenza vaccine. However, vaccination rates among healthcare personnel are extremely poor; less than 40% of personnel are immunized in most facilities. * One or more high-risk medical conditions including diabetes, current cancer treatment, or chronic heart, lung, or kidney disease. ** Healthcare workers included persons currently employed in healthcare occupations, regardless of setting, and persons currently employed in healthcare settings without a healthcare occupation.

8. Influenza Vaccination for Healthcare Workers Healthcare worker influenza vaccinations are supported by National Foundation of Infectious Diseases CDC Advisory Committee on Immunization Practices (ACIP) CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Healthcare Worker Influenza Vaccination Improves patient outcome Decreases worker absenteeism Is a measurable patient safety indicator Recommend monitoring and documentation of immunization and declination rates (as of 2006) Numerous bodies strongly support the concept of healthcare workers getting a flu shot. NFID ACIP HICPAC Healthcare Worker Vaccination is a good thing - It improves patient outcomes Decreases sick days for employees It is also considered a measurable patient safety indicator It is now recommended by the CDC to monitor immunization and declination rates.Numerous bodies strongly support the concept of healthcare workers getting a flu shot. NFID ACIP HICPAC Healthcare Worker Vaccination is a good thing - It improves patient outcomes Decreases sick days for employees It is also considered a measurable patient safety indicator It is now recommended by the CDC to monitor immunization and declination rates.

9. Why Should We Promote Influenza Vaccination for HCWs at the Cleveland Clinic? It is not pleasant to have the flu! Patient safety issue Nosocomial influenza (HCW to patient) is a risk that can be militated Have you washed you hands? And have you had your flu shot? JCAHO Guidelines Business model Reduce illness leave Avoid presenteeism Health outcomes research If model works for CCF has implications for 10 million HCWs nationwide

10. Influenza ImmunizationsCleveland Clinic Employees Flu clinics for all employees Nursing in-patient units and ambulatory clinics will be providing vaccine to unit/clinic employees in October-November Family Health Centers will also have vaccine available to patients and HCWs in October Mandatory participation system via the Intranet

12. Mandatory Participation

13. Mandatory Participation

14. 2007 Employee Influenza Vaccination Program All CCHS hospitals participating Leadership dashboard showing participation rates in development by Medical Operations Hope to have ready by start of program October 29 Request leadership encourage participation by all employees

16. Use of the Intranet to Enhance Influenza Vaccination The overall vaccination rate increased from 38% in 2004 to 55% in 2005 (p<0.000001)

17. 2006 Employee Influenza Vaccination Program

18. 2006 Employee Influenza Vaccination ProgramCCHS Employee Participation

19. ProgramsExamples of multidisciplinary collaboration facilitated by QPSI Hand hygiene � First line of defense against hospital acquired infection Surveillance for multi-drug resistant organisms IHI Bundles and Catheter related bloodstream infections Surgical Infection Prevention Influenza Vaccination Program

20. Challenges for Employee Influenza Vaccination Program Geography Workplace culture Barriers to accurate determination of compliance rates Ability to link processes with outcomes � opportunity to enhance practice

21. Dashboard:Portal for Providers, Payers and PatientsWhat Should Be Provided? Focus on process measurements as well as �rates� and �numbers� Drill down to variety of levels of specific and sensitive information Providers could use to assess �real time� quality improvement Payers could use to assess outcomes Health care workers could use to assess safety

22. Quality Dashboards

23. Process Improvement and Accountability

24. Infectious diseases specialists are one important resource for providing input, but many other professionals also contribute to optimal care for patients with infections. Like all patient safety endeavors, multidisciplinary collaboration is key! Infectious diseases specialists are one important resource for providing input, but many other professionals also contribute to optimal care for patients with infections. Like all patient safety endeavors, multidisciplinary collaboration is key!

25. Acknowledgements Infection Control and Hospital Epidemiology Team Steven Gordon Thomas Fraser Steven Schmitt Mary Bertin Cynthia Fatica Michelle Scarpelli Joan Kowalczyk Megan DiGiorgio Persis Sosiak Maria Caserta John Baker QPSI Michael Henderson Jackie Matthews Nursing Quality Monica Weber