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HAI Cluster Call Summary
August 11, 2010
10:00 – 11:30am
General Information
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7th Annual IHC Conference –September 1, 2010 Scheman Building in Ames.
 Keynote speaker; Dr. David Nash, internationally recognized physician for his work in
outcomes management and quality of care improvement. He will speak on the challenge of new
levels of transparency and public accountability.
 Dr. Nash will also present in an afternoon breakout session on governance for quality and safety
and how hospital boards will meet the challenge of reform.
 Preconference sessions on Lean Basics and Medical Home
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Hospital Learning Community Work Day – September 2, 2010 Scheman Building in Ames
 Changes to the structure of the day
 Brochure and registration for one or both conferences on the IHC website at www.ihconline.org
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Spread Exercise Dashboard
 The Spread Exercise dashboard has been completed
 Will be sent to hospital CEOs, CNEs and quality leaders
 Will compare a hospital’s progress trends to state, district, and similar-sized hospitals in
aggregate
 Will begin sending the dashboards to individual hospitals in October
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New IHI Improvement Map Processes
 Anticoagulation Management – link is available in the IHC anticoagulation toolkit
 Essential Care for Frail Older Patients
 Glycemic Control in Non-Critically Ill Patients
 I-Map processes have been updated with new resources
 Goo to www.ihi.org. Click on the Improvement Map icon on the IHI Welcome Page to access
the I-map
 There is NO CHARGE OR FEE to use the I-Map
Resources
 Website for Hospitals in Pursuit of Excellence/American Hospital Association www.hpoe.org
- Has resources (toolkits, standards, guidelines webinars, podcasts) on multiple topics
such as Care Coordination, HAI, Medication Management, Patient Safety
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IDPH HAI REDUCTION PROJECT UPDATE
Gerd Clabaugh provided an update on the HAI Reduction Project
 Subgroup meetings were held in late July; they endorsed the core CDC strategies for
interventions.
 Kate Ellingson, CDC expert on hand hygiene will discuss the interventions at the IHC Annual
Conference on 9/1/10
 On 9/2/10 at the HLC Conference Kate will share best practices in hand hygiene that the CDC
has identified
 NHSN training will be sponsored by IDPH in four sessions – 8/12, 8/16, and 8/18. Sessions
will be recorded and posted on the IDPH website
 Training is also available on the CDC website
 CDC released its final rule for FY2011 PPS hospitals. Beginning with 1/1/11hospital
discharges, PPS hospitals will be required to report central line-associated bloodstream
infections (CLABSIs) in ICUs and high-risk nurseries. It also includes reporting of surgical site
infections through NHSN beginning with 1/2/12 discharges.
 Check the IDPH website for information and tools http://www.idph.state.ia.us/hai_prevention
 The fall healthcare worker immunization campaign kick-off will begin soon. Watch for IHC
communication.
 MRSA, CLBSI, and SSI information will be coming from IHC.
 IHC received an earmark for regional Iowa provider training. More information will be
available at the IHC Annual Conference on 9/1/10.
HAND HYGIENE
Dr. Thomas Zweng from Novant Health in Charlotte, NC will speak at the IHC Annual Conference on
9/1/10 on improving hand hygiene compliance. At Novant, hand hygiene is a red rule along with 2
identifiers for patient identification. Those two processes MUST be done EVERY TIME.
At the HLC on 9/2/10, representatives from larger and smaller Iowa hospitals will share their strategies
for improving hand hygiene.
Discussion - What are hospitals doing to ensure hand hygiene is done and done correctly?
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Iowa Health - Des Moines developed a formal hand hygiene campaign in 2008, Just One Touch.
 In 3 months, decrease in all infections except surgical
 Still maintaining improvement
 Continue to monitor; from 3,000-4,000 observations/month to about 1,000 observations/month
 Added a question to Press-Ganey patient survey
 Annual online staff education – staff signs a pledge annually, includes to keep hands healthy
 Also used in physician recredentialing
 Observations done by “secret shoppers” who submit data into Survey Monkey
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Julie will share a card that contains the Survey Monkey data format
It was noted that there is an I-Phone application available to do real time observations which tabulates
results at the server site.
Ottumwa Regional Hospital reported they are doing hand hygiene activities similar to Iowa Health
Des Moines.
 Documentation of those not in compliance and follow up with staff and physicians
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CAUTI
Baseline data collection through Spread Exercise Survey in 2010
July Spread Exercise Survey results show 52% of Iowa hospitals have full deployment of the CAUTI
elements
 25% of Iowa hospitals in partial deployment
 IHC CAUTI Toolkit – www.ihconline.org
 Improvement Map has CAUTI process - http://www.ihi.org/imap/tool/#
 IHI Expedition – Preventing CAUTI to begin 9/1/10; is a 6-part web-based program. Cost is $750 per
organization unless your hospital is a Passport member. More information is available on the IHI
website.
Discussion
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Regional Medical Center – Manchester implemented automatic post surgery orders a few months ago.
If patient had a Foley inserted, it was to be removed on Day 2.
 Discussed post op orders with surgeons – do an evaluation on Day 2
 Do a daily assessment of the need for a the catheter
 Will build into new electronic record
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Iowa Health Des Moines has not developed criteria for catheter insertion yet.
 They have a flow sheet with indicators for continuing a catheter
 Do a daily review of the continuing need
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Ottumwa Regional Hospital uses bladder scans on acute rehab unit
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Mercy – Dubuque ordered bladder scanners for every floor
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Mercy – Mason City ordered bladder scanners for every floor.
 Physicians have to document the reason for continuing the catheter.
 Every day at 6:00am – medical record alert regarding continuation of the patient’s catheter
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MRSA
2010 IHC deployment goal – 60%
 Exceeded goal of 60% – 73% of Iowa hospitals report they have fully deployed the MRSA elements
 21% reporting partial deployment of the elements
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St. Luke’s Hospital – Cedar Rapids – is experiencing more community-acquired infections than
healthcare associated infections over the last two years
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Mercy – Sioux City- worked on a strong community education plan but got sidetracked with H1N1
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Pella Regional Health Center – Pella has experienced clinic and hospital patients sometimes being
admitted and deny a history of MRSA or don’t know. When a patient is identified with MRSA,
pamphlets are sent to the patient with an explanation of MRSA.
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It was noted that the Iowa Department of Public Health did a great communication plan for H1N1.
Perhaps they could do an equality strong campaign regarding MRSA.
CLOSTRIDIUM DIFFICILE
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Reminder that Kate Ellingson with the CDC will discuss C. diff prevention at the IHC Annual
Conference on September 1.
Improvement Map has Antibiotic Stewardship process at http://www.ihi.org/imap/tool/
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Ecolab has an EPA-approved, ready-to-use product that kills C. diff spores when used in daily and
terminal room cleaning. The product name is VIRASEPT
HEALTHCARE WORKER IMMUNIZATION
2009-2010 deployment goal – 95%
Final immunization rate for 2009-2010 campaign – 91%
2010 goal – 95% again
Congratulations!
CENTRAL LINE INFECTIONS
Reminder that improvement elements for central lines can also apply to PICC lines and event to IV
insertion. Any time the patient’s skin is punctured, there is an opportunity for infection.
St. Luke’s Hospital – Sioux City has been doing will overall with CLIs. Have experienced a few
problems with oncology patients.
 Biopatch is a mandatory part of the insertion kit (Biopatch encircles the insertion site).
Not used on NICU patients
Mercy – Dubuque is using alcohol-impregnated caps over access portals. Eliminates the need to scrub
the hub
VENTILATOR ASSOCIATED PNEUMONA
IHI added a 5th element to the VAP bundle….daily oral care with Chlorhexidine 0.12%
 A tip for remembering to do the daily oral care is to schedule it as a medication
 Expectation that the 5th element will be included in the VAP bundle for the January
2011Spread Exercise Survy
Iowa Health - Des Moines is researching what solution they will use for daily oral care.
Finley – Dubuque is currently using a Sage 24 hour packet for cleaning and rinsing.
Improvement Map has process - http://www.ihi.org/imap/tool/#
SURGICAL CARE IMPROVEMENT PROGRAM (SCIP)
July 2010 Spread Exercise data indicated that 70% of Iowa hospitals have fully deployed the SCIP
elements
Note: According to the Iowa Hospital Association, there are less than 10 hospitals in Iowa that do not
provide any surgical services and about 12 hospitals offer some surgical services but do 20 cases or less
per year. The SCIP measures would provide a valuable checklist for those hospitals that don’t do a large
volume of cases.
Mercy – Iowa City shared that they struggle with post-surgical glucose control levels. It’s a challenge
to get glucose <200 on POD 1and 2. Drilling down to see what they need to do differently. When the
IV insulin is turned off, there is a bump in the glucose level.
Improvement Map process for SCIP - http://www.ihi.org/imap/tool/#
No discussion on this topic
GENERAL QUESTION
Are hospitals training staff or have trained staff on the teachback technique for patient
education?
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Iowa Health - Des Moines and St. Luke’s – Cedar Rapids have used it.
Next HAI Call
November 11, 2010
G:\IHC\Node\Conference Calls\2010\Cluster Call Summaries\August Summaries\HAI Call 8.11.10.doc
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