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Targeting Zero SSIs: The Implementation of a Multi-Site Initiative
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Poster Abstracts / American Journal of Infection Control 44 (2016) S28-S82
HH Champion Program was implemented at the unit level with front line staff with daily huddles for less than one minute reinforcements for staff. Weekly computer generated emails are sent each Monday to unit staff for continual data review to share with unit staff. Product dispensers were repositioned to improve accessibility at the point-of-care in patient rooms. HAI rates and HH data compared. RESULTS: Overall hospital HH compliance showed a 39 point increase from 57 to 79 Hand Hygiene Compliance Index (HHCI) in Sept 2015. Overall hospital onset MRSA rate dropped from 3.94 to 1.98 per 10,000 patient days—a 50% reduction from 2013 (pre) to 2015 (post implementation). No Readmission (0.24% in 2013 vs 0.00% in 2015) penalties were paid in 2015. There were also no ACA related penalties paid in 2015. CONCLUSIONS: Continual interventions were necessary to improve HH compliance data with an electronic program that has accurate, reliable, real-time data. Administrative actions significantly impacted HH results in February 2015. HAI rates and financial ramifications were positively impacted with increased HH compliance.
9-219 Using Process Measures to Improve Compliance with Evidence-Based Infection Prevention Activities Elizabeth Walters, BS, RN, CIC, Infection Preventionist, UNC Health Care BACKGROUND: Although at our facility, we have seen substantial reductions in our healthcare-associated infections over time, we have not collected process measure data for compliance with evidencebased infection prevention activities related to ventilator associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), or catheter-associated blood stream infection (CLABSI). METHODS: Hospital Epidemiology recruited >60 clinical nurses throughout the hospital to audit each patient with a urinary catheter, central line and ventilator. The auditors were trained using a standardized tool to assess compliance with evidence-based practices for patients with invasive devices in place. The audit tool was designed to gather evidence-based process measure data related to VAP, CAUTI, and CLABSI for all inpatients in one day. RESULTS: Our compliance results showed that for central lines a chlorhexidine gluconate impregnated patch was only correctly applied 53% of the time and disconnected IV tubing was properly capped off only 73% of the time. Patients with urinary catheters only had pericare documented 60% of the time. We identified issues with placement of urinary catheter drainage tubing and bag (collection bag off the floor 83% and correct tubing set-up only 43% of the time). Ventilated patients had chlorhexidine gluconate oral care rinse documented 65% of the time and sedation interruption and spontaneous breathing trials were documented in less than 10% of patients. Six months later, an audit was repeated for compliance with application of a chlorhexidine gluconate impregnated patch with a 16% improvement of compliance to 69%. CONCLUSIONS: The findings of a process measure compliance audit helped shape many infection prevention activities and set fiscal year improvement goals for our facility. Ongoing efforts include the plans for ongoing auditing and focused interventions for CLABSI and CAUTI prevention. By collecting process measure data, we can better design
interventions to improve compliance with key evidence based practices for infection prevention.
9-253 Targeting Zero SSIs: The Implementation of a Multi-Site Initiative Susan Becnel Waguespack, BSN, RN, CIC, Infection Prevention/ Employee Health Coordinator, St. Elizabeth Hospital; Amy K. Seale, RN, BSN, Surgery Unit Supervisor, Our Lady of Angels Hospital; Janice Augustine, RN, MSN, CIC, Infection Prevention Coordinator, Our Lady of Angels Hospital BACKGROUND: The development of new evidence-based standards to reduce the occurrence of hospital-acquired infections (HAIs) is a major priority in healthcare. There is a large body of evidence linking the natural bacterial flora present on skin to a variety of HAI’s, including surgical site infections (SSIs), which account for almost 31% of HAI’s. It is well-recognized that skin antisepsis of the entire skin surface, not just the operative area, is a fundamental component for the prevention of SSIs. Much of the recent evidence on skin antisepsis has been focused on chlorhexidine (CHG). In addition to its broad spectrum antimicrobial activity, CHG demonstrates cumulative and residual activity against skin pathogens, a low incidence of skin hypersensitivity, and minimal microbial resistance. METHODS: We collected baseline data in 2013 on SSI in two of the hospitals in our system. During that time period, the standard of care was site-specific surgical prep the morning of surgery. In 2014 we implemented a new practice at Site 1 that focused on joint procedures and implemented chin-to toe skin decontamination using a 2% CHG cloth on the morning of surgery. At Site 2 we implemented chin-to-toe skin decontamination using a 2% CHG cloth the night before and morning of surgery, and included all surgical procedures. We continued to track SSI rates and began tracking compliance to the new practice at both sites. RESULTS: Implementation resulted in significant decreases in SSI and return on investment due to preventable costs of HAIs. Site 1 witnessed a 53% decrease in infections and a cost savings of $176,359. Site 2 witnessed a 88% decrease in infections and a cost savings of $636,532. CONCLUSIONS: The use of 2% CHG cloths makes the CHG application process fast and simple, leading to improved compliance to the new practice, SSI reduction, and decreased cost.
9-255 Impact of Reduced Isolation and Contact Precaution Procedures on Infection Rates and Facility Costs at a Non-Profit Acute Care Hospital Nina Deatherage, BSN, RN, PHN, CIC, Infection Prevention & Control Lead, Marshall Medical Center BACKGROUND: Contact precautions (CP) and isolation are commonly used to reduce transmission and infection risk due to methicillin-resistant Staphylococcus aureus (MRSA). Despite potential negative impacts on the quality of nursing care, patient satisfaction, and CP-associated costs, lack of clarity regarding CP use in non-infected carriers and the absence of conservative alternatives continue to drive its practice. METHODS: In October 2014, a facility-wide change in CP protocols and infection control (IC) procedures was initiated at our
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016
Poster Abstracts / American Journal of Infection Control 44 (2016) S28-S82
HH Champion Program was implemented at the unit level with front line staff with daily huddles for less than one minute reinforcements for staff. Weekly computer generated emails are sent each Monday to unit staff for continual data review to share with unit staff. Product dispensers were repositioned to improve accessibility at the point-of-care in patient rooms. HAI rates and HH data compared. RESULTS: Overall hospital HH compliance showed a 39 point increase from 57 to 79 Hand Hygiene Compliance Index (HHCI) in Sept 2015. Overall hospital onset MRSA rate dropped from 3.94 to 1.98 per 10,000 patient days—a 50% reduction from 2013 (pre) to 2015 (post implementation). No Readmission (0.24% in 2013 vs 0.00% in 2015) penalties were paid in 2015. There were also no ACA related penalties paid in 2015. CONCLUSIONS: Continual interventions were necessary to improve HH compliance data with an electronic program that has accurate, reliable, real-time data. Administrative actions significantly impacted HH results in February 2015. HAI rates and financial ramifications were positively impacted with increased HH compliance.
9-219 Using Process Measures to Improve Compliance with Evidence-Based Infection Prevention Activities Elizabeth Walters, BS, RN, CIC, Infection Preventionist, UNC Health Care BACKGROUND: Although at our facility, we have seen substantial reductions in our healthcare-associated infections over time, we have not collected process measure data for compliance with evidencebased infection prevention activities related to ventilator associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), or catheter-associated blood stream infection (CLABSI). METHODS: Hospital Epidemiology recruited >60 clinical nurses throughout the hospital to audit each patient with a urinary catheter, central line and ventilator. The auditors were trained using a standardized tool to assess compliance with evidence-based practices for patients with invasive devices in place. The audit tool was designed to gather evidence-based process measure data related to VAP, CAUTI, and CLABSI for all inpatients in one day. RESULTS: Our compliance results showed that for central lines a chlorhexidine gluconate impregnated patch was only correctly applied 53% of the time and disconnected IV tubing was properly capped off only 73% of the time. Patients with urinary catheters only had pericare documented 60% of the time. We identified issues with placement of urinary catheter drainage tubing and bag (collection bag off the floor 83% and correct tubing set-up only 43% of the time). Ventilated patients had chlorhexidine gluconate oral care rinse documented 65% of the time and sedation interruption and spontaneous breathing trials were documented in less than 10% of patients. Six months later, an audit was repeated for compliance with application of a chlorhexidine gluconate impregnated patch with a 16% improvement of compliance to 69%. CONCLUSIONS: The findings of a process measure compliance audit helped shape many infection prevention activities and set fiscal year improvement goals for our facility. Ongoing efforts include the plans for ongoing auditing and focused interventions for CLABSI and CAUTI prevention. By collecting process measure data, we can better design
interventions to improve compliance with key evidence based practices for infection prevention.
9-253 Targeting Zero SSIs: The Implementation of a Multi-Site Initiative Susan Becnel Waguespack, BSN, RN, CIC, Infection Prevention/ Employee Health Coordinator, St. Elizabeth Hospital; Amy K. Seale, RN, BSN, Surgery Unit Supervisor, Our Lady of Angels Hospital; Janice Augustine, RN, MSN, CIC, Infection Prevention Coordinator, Our Lady of Angels Hospital BACKGROUND: The development of new evidence-based standards to reduce the occurrence of hospital-acquired infections (HAIs) is a major priority in healthcare. There is a large body of evidence linking the natural bacterial flora present on skin to a variety of HAI’s, including surgical site infections (SSIs), which account for almost 31% of HAI’s. It is well-recognized that skin antisepsis of the entire skin surface, not just the operative area, is a fundamental component for the prevention of SSIs. Much of the recent evidence on skin antisepsis has been focused on chlorhexidine (CHG). In addition to its broad spectrum antimicrobial activity, CHG demonstrates cumulative and residual activity against skin pathogens, a low incidence of skin hypersensitivity, and minimal microbial resistance. METHODS: We collected baseline data in 2013 on SSI in two of the hospitals in our system. During that time period, the standard of care was site-specific surgical prep the morning of surgery. In 2014 we implemented a new practice at Site 1 that focused on joint procedures and implemented chin-to toe skin decontamination using a 2% CHG cloth on the morning of surgery. At Site 2 we implemented chin-to-toe skin decontamination using a 2% CHG cloth the night before and morning of surgery, and included all surgical procedures. We continued to track SSI rates and began tracking compliance to the new practice at both sites. RESULTS: Implementation resulted in significant decreases in SSI and return on investment due to preventable costs of HAIs. Site 1 witnessed a 53% decrease in infections and a cost savings of $176,359. Site 2 witnessed a 88% decrease in infections and a cost savings of $636,532. CONCLUSIONS: The use of 2% CHG cloths makes the CHG application process fast and simple, leading to improved compliance to the new practice, SSI reduction, and decreased cost.
9-255 Impact of Reduced Isolation and Contact Precaution Procedures on Infection Rates and Facility Costs at a Non-Profit Acute Care Hospital Nina Deatherage, BSN, RN, PHN, CIC, Infection Prevention & Control Lead, Marshall Medical Center BACKGROUND: Contact precautions (CP) and isolation are commonly used to reduce transmission and infection risk due to methicillin-resistant Staphylococcus aureus (MRSA). Despite potential negative impacts on the quality of nursing care, patient satisfaction, and CP-associated costs, lack of clarity regarding CP use in non-infected carriers and the absence of conservative alternatives continue to drive its practice. METHODS: In October 2014, a facility-wide change in CP protocols and infection control (IC) procedures was initiated at our
APIC 43rd Annual Educational Conference & International Meeting | Charlotte, NC | June 11-13, 2016