1 / 92

Objectives

Objectives. At the end of this session, participants will be able to: Define Interventional Patient Hygiene (IPH) List the components of an IPH Program Develop a strategy for implementing IPH Understand the importance of skin antisepsis in SSI prevention VAP prevention progress update.

pleasance
Télécharger la présentation

Objectives

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Objectives At the end of this session, participants will beable to: • Define Interventional Patient Hygiene (IPH) • List the components of an IPH Program • Develop a strategy for implementing IPH • Understand the importance of skin antisepsis in SSI prevention • VAP prevention progress update

  2. What Is IPH?

  3. Definitions Non-Clinical:Providing patient care practices that will reduce the choices of a healthcare-acquired infectionClinical:IPH is a comprehensive evidenced based intervention and measurement model for reducing the bioburden of both the patient and healthcare worker.

  4. IPH Practices/Prevention Outcomes

  5. ICP Opportunity….?

  6. PressureUlcers SSI VAP BSI UTI

  7. A Convincing Strategy for IPHThe Five C’s

  8. The FiveC’s: • Caregiver Knowledge • Consumer Public Disclosure • CostsHAI’s • Court Malpractice • Control IPH

  9. Interventional Patient Hygiene Surveyn=453 • ICP 30.9% • CCRN 22.8% • CCRN Mgr/Specialist 15.5% • RN 42.2% 48.8% employed >20 years 67.7% Community Hospital 28.3% University/Academic

  10. Identify Components of IPH • Hand Hygiene 98.7% • Oral Hygiene 94.8% • Early Pre-op Skin Prep 69.9% (night before and morning of surgery) • Bathing/Skin Assessment 93.5% • Incontinence Care 92.4%

  11. Healthcare-Acquired Infection Rates VAP 67% Pressure Ulcer 43%

  12. Scientific Evidence/ IPH • Pressure Ulcer 72% • SSI 66% • VAP 86% • UTI 75% • LOS 74% • MRSA/VRE 77%

  13. ICP’s Questions • Education about IPH Components (within last 2 years) Hand Hygiene 98.6% Oral Hygiene 76.4% Early Pre-op Skin Prep 49.1%(night before/morning) Bathing/Skin Assessment 40.5% Incontinence Care 31.8%

  14. ICP’s (con’t) • ICP Involvement in Development IPH Protocol YES: 37.6% NO: 63.3% • Policy for IPH in your Institution YES: 39.3% NO: 45.3% Don’t Know: 15.2%

  15. CCRN/RN Questions • Policy for IPH in Your Institution: YES: 48.4% NO: 34.7% Don’t Know 16.8%

  16. CCRN/RN (con’t) Written Policy for:Documentation Forms for: Oral Care 77% 81% Bathing/Skin Assessment 68% 86% Incontinence Care 54% 60%

  17. IPH Discussed at Orientation/In-Service Yes: 42.2% No: 40.4% Don’t Remember: 17.3% Skipped Question: 17%

  18. Ranking of Factors Relating to IPH Very ImportantSomewhat Important Adequate/AppropriateSupplies 94% 4% Adequate Time 90% 7% Standardization of Protocol 86% 11% Documentation forms for monitoring 73% 25%

  19. How Do We Increase HCWs Knowledge of IPH ?& How Do We Develop and Implement a Strategy for IPH?˙Ownership and Back to Basics

  20. PressureUlcers SSI VAP BSI UTI

  21. 2. Consumer • 2005 - National Telephone Survey*: Will Consumers Use Public Disclosure Data When Choosing a Hospital? • 93% of respondents (9 in 10) said knowing a hospital infection rate would influence their selection of a hospital *McGuckin M. American Journal of Medical Quality 2006 - In press

  22. *Less than one-half of one percent

  23. Does IPH Play a Role in State Reporting/Public Disclosure? SSI VAP UTI “Hospital Infection data low; too low?” “Underreporting hurts patients” Philadelphia Inquirer - May 22, 2006

  24. 3. Costs Ref: Am J Infec Control 2005;33:542-7

  25. Does IPH Play a Role in Costs of HAI’s Traditional Health Cost Controls Modern Cost Care Controls Spending Time Traditional cost controls Modern cost controls Negotiate prices and service fees Stop doing things that don’t work Offer fewer benefits to employees Use cost-effective products Shift some costs to patients Improve procedures Reference: Am J Infec Control 2005;33:542-7

  26. 4. Court If Science or Evidence Based Medicine Does Not Increase Hand Hygiene Compliance Then “Woe to you lawyers also! You lay impossible burdens on men but will not lift a finger to lighten them.”Luke 11-46-47

  27. Guinan J, McGuckin M, et al,A descriptive review of malpractice claims for healthcare-acquired infections in Philadelphia. Am J Infect Control 2005;33:310-2.

  28. HAI’S Cases (Most Frequent)

  29. Can IPH Reduce Malpractice Claims • C. difficile • MRSA • Pre-op Prep

  30. 5. Control Good Medical Care? It’s a coin flipThe Philadelphia Inquirer - March 16, 2006 U.S. patients receive proper medical care from doctors and nurses 55% of timeN.E.J.M. - Vol 354, No 11, 2006

  31. PressureUlcers SSI VAP BSI UTI

  32. Control Through IPH UTI Rate- Removal of Prepackaged Bath Product QTR 3 FY05

  33. Is There Evidence to Support This Trend? • High colony count found in bath water is similar to the number of bacteria found in urine from patients with UTIs.R.Shannon et al, Journal of HealthCare Safety, Compliance & Infection Control, April 1999; Vol. 3, No. 4, pg. 180-184 • Bath water could serve as a high magnitude microbial reservoir of potentially antibiotic resistant organisms. R.Shannon et al, Journal of HealthCare Safety, Compliance & Infection Control, April 1999; Vol. 3, No. 4, pg. 180-184 • Prepackaged bathing showed lower microbial counts than basins M. Vernon, DrPH; et al, Archives of Internal Medicine, February 2006; • Disposable Bed Baths are a desirable form of bathing Critically Ill patients. E. Larson, RN, PhD. et. al, AJCC, May 2004; Vol. 13, No. 3

  34. Clinical Process Improvement UTI BundleMiller Success Story

  35. Urinary Tract Infection Bundle (con’t)

  36. Urinary Tract Infection Bundle (con’t)

  37. VAP Rate vs. VAP Care Bundle

  38. Role of ICP in IPH • Partnership with nursing • Protocols/policies that include patient • Product evaluations • Prospective evaluations

  39. “GOT CLEAN PATIENTS?” Don’t slide into bad habits, Remember… Hand Hygiene Oral Care Catheter Site Care Skin care

  40. Prevention of Surgical Site Infections Robert Garcia, BS, MMT(ASCP), CIC Infection Control Professional & Consultant

  41. PressureUlcers SSI VAP BSI UTI

  42. SSIs: Magnitude of the Problem • 1996: 28.4 million ambulatory surgery procedures in the U.S. (CDC, National Center for Health Statistics) • 2003: 30.8 million inpatient surgical procedures and 9.7 million (37%) of those performed on patients 65 yrs and older (CDC, National Center for Health Statistics) • NNIS: SSIs occur in 2.6%1 of all surgeries = 1.5 million SSIs annually2 • SSIs are the 3rd most common HAI1 • Attributable cost: $25,546 (range $1,783 - $134,602)3 1. Mangram AJ, et al., Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention, Hospital Infection Control Practices Advisory Committee, Atlanta GA. 2. SSI total calculated by multiplying SSI rate from ref. #3 by surgical procedure numbers from ref. #1 and 2. 3. Stone PW, et al., Am J Infect Control. Nov 2005;33(9):501-9.

  43. Relative Costs of HAIs

  44. Risk Factors for SSI: The Patient • Age • Nutritional status • Diabetes • Nicotine use • Obesity • Coexistent infection • Colonization • Altered immune response • Long preoperative stay How effectively can we control these risk factors?

  45. Risk Factors for SSI: Pre- and Intraoperative • Inappropriate use of antimicrobial prophylaxis • Infection at remote site not treated prior to surgery • Shaving the site vs. clipping • Long duration of surgery • Improper skin preparation • Improper surgical team hand antisepsis • Environment of the room (ventilation, sterilization) • Surgical attire and drapes • Asepsis • Surgical technique: hemostasis, sterile field To a great extent, this is what we can control!

  46. Goal Zero • The All-or-None Measurement • An option for calculating performance • Denominator = No. of pts. eligible to receive at least 1 or more discrete elements of care • Numerator = No. of pts. who actually received care • No partial credit is given • The Centers for Medicare & Medicaid (CMS) has moved to the “all-or-none” approach Nolan T, Berwick D. All-or-none measurement raises the bar on performance. JAMA 2006;295:1168-70.

  47. Defining Appropriate Care in Surgery

  48. Advantages of All-or-None Measurement • “….all-or-none measurements more closely reflects the interests and likely desires of patients. This is especially true when process components interact with each other synergistically….violation of a single step in the sterile technique in surgery may vitiate the benefits of proper execution of all other steps…”1 • The Take Away Message: in SSI prevention, it makes little sense to assure that the surgeon has washed his hands properly if the patient’s skin has not had optimal prepping 1. Nolan T, Berwick D. JAMA 2005.

More Related