Washington State Hospital Association Partnership for Patients Safe Table Reducing Hospital Acquired Infections July 31,

1. Washington State Hospital AssociationPartnership for PatientsSafe TableReducing Hospital Acquired InfectionsJuly 31, 2013 Amber Theel, Director Patient Safety Presented at Washington State Hospital Association Safe Table, July 31, 2013

2. Partnership for Patients • 40 – Percent reduction in harm • 20 – Percent reduction in readmissions • 13 – By December 2013 Saving Lives 2 Presented at Washington State Hospital Association Safe Table, July 31, 2013

3. 10 Targeted Strategies Infection Reduction: • Catheter-associated urinary tract infections (CAUTI) • Central line-associated blood stream infections (CLABSI) • Surgical site infections (SSI) • Ventilator-associated pneumonia (VAP) Nursing Care: • Injuries from falls and immobility • Pressure ulcers High Risk: • Adverse drug events • Obstetrical adverse events • Venous thromboembolism or blood clots (VTE) Continuity of Care: 10. Prevention of readmissions Cultural Transformation Leadership Engagement Patient and Family Engagement 3 Presented at Washington State Hospital Association Safe Table, July 31, 2013

4. Submission rates for most recent quarter: CLABSI: 84.8% VAP: 92.4% CAUTI: 86.4% SSI: 87.5% Falls: 69.2% Pressure Ulcers: 90.5% EED: 92.1% VTE: 81.1% Readmission: 100.0% ADE: 35.8% Leadership, Patient and Family: 64.2% Harm and Readmissions Reduction Results Below the Line is Better 4% Readmissions Pressure Ulcers CAUTI CLABSI Falls VAP OB ADE SSI VTE Achieve by December 2013 Baseline 2010 18% 24% 28% 33% 38% 37% Goal 20% 40% Goal 40% 54% 82% Green – Reached Goal Yellow – Moving in Right Direction Red – Work to be Done Based on submitted data through Q1 2013 for CLABSI and CAUTI Base on submitted data through Q4 2012 SSI, OB, and Falls Based on submitted data through Q3 2012 for Readmissions, VTE, and Pressure Ulcers Based on submitted data through March 2013 for ADE 7/9/2013 Presented at Washington State Hospital Association Safe Table, July 31, 2013

5. Obstetrical Adverse Events - EED plus Safe Deliveries Roadmap • Readmissions - Care transitions standardization • CAUTI - Monthly support for hospitals with high rates Dr. Sanjay Saint, Dr. TimDellit, and Carol Bradley, RN • CLABSI - Action Bundle plus high rate support • VAP - Action Bundle plus high rate support • SSI - Action Bundle plus glycemiccontrol • VTE - Action Bundle • Falls - Execution of leading practices • Pressure Ulcers - Risk assessment, prevention, early identification and treatment • ADE - Action Bundle • Global Strategies • Monthly reports to hospitals plus transparency • Engagement: leadership, patient, and family • Culture

6. Safety Net AssessmentMedicaid Quality Incentive Infection Control Measures Presented at Washington State Hospital Association Safe Table, July 31, 2013

7. Selected Measures: Acute, Rehabilitation, and Pediatric Services Infection Prevention Improvement Measure - Catheter-Associated Urinary Tract Infections Per Patient Day (Hospital-wide) Sustaining Measure -Health Care Personnel (HCP) Influenza Vaccination Presented at Washington State Hospital Association Safe Table, July 31, 2013

8. 11 Presented at Washington State Hospital Association Safe Table, January 31, 2013

9. Flu Immunization Required Reporting Denominator categories: • All employee HCP: Includes both full-time and part-time HCP employees • Non-employee HCP: Licensed independent practitioners (physicians, advance practice nurses, and physician assistants) • Non-employee HCP: Adult students/trainees and volunteers Numerator categories: • Influenza vaccinations • Medical contraindications • Vaccinations outside facility • Declinations • Unknown status *Facilities are required to report all numerator categories for the three denominator categories 2012-2013 HCP Influenza Vaccination Rates 87.58% 9 Presented at Washington State Hospital Association Safe Table, January 31, 2013

10. Visitor Restrictions During Flu Season • Special restrictions or screening during respiratory/flu season in high risk populations? • OB, Women and Newborn, NICU and pediatric facilities.  • How often are facilities screening visitors for illnesses? • How do you identify when patients have been screened? • Criteria for restrictions? • Age, relationship to patient?

11. State Reporting Hospital Acquired Infection Presented at Washington State Hospital Association Safe Table, July 31, 2013

12. Ventilator Associated Pneumonia (VAP) • 250,000 VAP in 2002 – 36,000 associated with death. • 3525 VAP reported in NHSN in 2011 • Rates varied by type of unit 0.0 to 4.9 per 1000 ventilator days. How will your facility measure VAP? Presented at Washington State Hospital Association Safe Table, July 31, 2013

13. MDRO - Challenges • States, Federal, consumer groups, etc., displaying disparate public HAI metrics and formats • Inter-facility communication not standardized for multidrug-resistant organisms (MDRO) & HAI history • Practices across labs not standardized • C. difficile infection (CDI) poorly understood, requiring uniform surveillance • MRSA infection high burden, high morbidity • Rise in MDROs, lack of standardized surveillance of antimicrobial usage 9 Presented at Washington State Hospital Association Safe Table, July 31, 2013

15. Questions? 10 Presented at Washington State Hospital Association Safe Table, July 31, 2013