Washington State Hospital Association
Partnership for Patients
Safe Table
Reducing Hospital Acquired Infections
July 31, 2013
Amber Theel, Director Patient Safety
Presented at Washington State Hospital Association Safe Table, July 31, 2013
Partnership for Patients
• 40 – Percent reduction in harm
• 20 – Percent reduction in readmissions
• 13 – By December 2013
Presented at Washington State Hospital Association Safe Table, July 31, 2013
2
10 Targeted Strategies
Infection Reduction:
1. Catheter-associated urinary tract infections (CAUTI)
2. Central line-associated blood stream infections (CLABSI)
3. Surgical site infections (SSI)
4. Ventilator-associated pneumonia (VAP)
Nursing Care:
5. Injuries from falls and immobility
6. Pressure ulcers
High Risk:
7. Adverse drug events
8. Obstetrical adverse events
9. Venous thromboembolism or blood clots (VTE)
Continuity of Care:
10. Prevention of readmissions
Presented at Washington State Hospital Association Safe Table, July 31, 2013
3
Harm and Readmissions Reduction Results
Below the Line is Better
CLABSI VAP
CAUTI
SSI
Falls
Pressure
Ulcers OB
4%
VTE
Readmissions
ADE
Achieve
by
December
2013
Baseline
2010
18%
40%
38%
24% 28%
33%
37%
Goal 40%
Goal
20%
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%
54%
82%
Green – Reached Goal
Based on submitted data through Q1 2013 for CLABSI and CAUTI
Base on submitted data through Q4 2012 SSI, OB, and Falls
Yellow – Moving in Right
Based on submitted data through Q3 2012 for Readmissions, VTE, and Pressure Ulcers
Red – Work to be Done
Based on submitted data through March 2013 for ADE
Presented at Washington State Hospital Association Safe Table, July 31, 2013
7/9/2013
Direction
1. Obstetrical Adverse Events - EED plus Safe 6.
Deliveries Roadmap
7.
2. Readmissions - Care transitions
8.
standardization
9.
3. CAUTI - Monthly support for hospitals with high
rates Dr. Sanjay Saint, Dr. Tim Dellit, and Carol
Bradley, RN
10.
4. CLABSI - Action Bundle plus high rate support
5. VAP - Action Bundle plus high rate support
•
•
•
SSI - Action Bundle plus glycemic control
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
Safety Net Assessment
Medicaid Quality Incentive
Infection Control Measures
Presented at Washington State Hospital Association Safe Table, July 31, 2013
Washington State Hospital Association
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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
Washington State Hospital Association
Presented at Washington State Hospital Association Safe Table, January 31, 2013
11
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
2012-2013 HCP Influenza Vaccination
• Medical contraindications
Rates 87.58%
• Vaccinations outside facility
• Declinations
• Unknown status
*Facilities are required to report all numerator categories for the
three denominator categories
Presented at Washington State Hospital Association Safe Table, January 31, 2013
9
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?
State Reporting Hospital Acquired Infection
Measures
Old State Law
New State Law
CMS
YES
(ICU only)
YES
(All inpatient areas)
YES
(ICU only)
Ventilator-associated pneumonia (VAP)
YES
NO
NO
Deep sternal wound for cardiac surgical site
infections
YES
YES
(until 2017)
NO
Total hip replacement surgical site infections
YES
YES
(until 2017)
NO
Total knee replacement surgical site infections
YES
YES
(until 2017)
NO
Vaginal hysterectomy surgical site infections
YES
NO
NO
Abdominal hysterectomy surgical site infections
YES
YES
YES
Colon surgical site infections
NO
YES
YES
Central line-associated bloodstream infections
(CLABSI)
Presented at Washington State Hospital Association Safe Table, July 31, 2013
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
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
Presented at Washington State Hospital Association Safe Table, July 31, 2013
9
Questions?
Presented at Washington State Hospital Association Safe Table, July 31, 2013
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