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A Quality Improvement Project on Hand Hygiene Compliance and Its Impact on Central Line Associated Blood Stream Infections
Poster Abstracts / American Journal of Infection Control 41 (2013) S25-S145
2011 rates went from a high of 7.72/1000 vent days (May 2011) to 2.65/1000 vent days with a median rate of 3.1/1000 vent days. 2012 saw an overall decline from a high of 5.41/1000 vent days (Jan 2012) to 0.0/1000 vent days for seven (7) months out of eleven (11) with a median of 1.2/1000 vent days. (Figure 1) Additional non-measured benefits include the following: continual patient care during transport/ necessary testing and no change in nurse-patient ratio for the remaining critically ill patients in the ICU. LESSON LEARNED: Reduction of harm to patients related to VAP relies on new and innovative ways to improve current processes and redesign roles to meet the needs of the patients. Dedication to timely defect analysis by the team with cycles of change in processes result in a positive outcomes.
Presentation Number 9-387 A Quality Improvement Project on Hand Hygiene Compliance and Its Impact on Central Line Associated Blood Stream Infections Linda Johnson MSN, RN, CIC, Manager Infection Prevention and Control, University of Missouri Health Care; Paula Bullock M.Ed, MT(ASCP), CIC, Infection Control Professional, University of Missouri Health Care; Eileen Phillips BSN, RN, CIC, Infection Control Professional, University of Missouri Health Care; Cathy Schlotzhauer BSN, RN, CIC, Infection Control Professional, University of Missouri Health Care; Jaime Basnett BSN, RN, CIC, Infecion Control Professional, University of Missouri Health Care ISSUE: The risk of developing Central Line-Associated Bloodstream Infection (CLABSI) depends on several factors. Emphasis on hand hygiene and proper use of alcohol-based hand rubs is a critical intervention in minimizing healthcare associated infections (HAI) that is supported by the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) guidelines. The objective of this Quality Improvement Project was to improve the hand hygiene compliance among all health care workers and decrease the rate of CLABSI. PROJECT: An action plan was developed to improve hand hygiene compliance among the hospital staff. Cornerstones of this plan were education, compliance monitoring, product selection, and product accessibility. Re-education on the importance of proper hand hygiene was conducted. Additionally, covert monitoring (via observation per WHO recommendation) of staff compliance was performed. Observers immediately intervened with non-compliant staff and followed with written notification of non-compliance to supervisory personnel. After careful review of available scientific data, an 85% ethyl alcohol product (Sterillium Comfort GelÒ *) was selected as a hand antiseptic. Product accessibility issues were identified and resolved with relocation of dispensers and reinforcement of refilling procedures. When a clinical infection was suspected, the patient’s blood was cultured per hospital protocol. The CDC/National Healthcare Safety Network (NHSN) CLABSI surveillance definitions were used. RESULTS: Based on a Poisson regression model, there is a statistically significant correlation between hand hygiene (HH) compliance rate and CLABSI rate (p<0.0001). For this quality improvement project, the baseline for HH compliance rate was almost 70% and baseline for the CLABSI rate was 4.22 per 1,000 device days. After implementing a Central Line Bundle and hand hygiene education, the HH compliance rate increased to 90% with a corresponding decreased CLABSI rate of 1.13/1,000 device days (Apr09 e Mar11). After implementation of staff hand hygiene monitoring, selection of
S101
an 85% ethyl alcohol gel hand sanitizer, and improved sanitizer accessibility, the HH compliance rate increased further to 98% with a corresponding decrease in CLABSI rate to 0.42/1,000 device days (Mar11 e Feb12). LESSON LEARNED: This quality improvement project illustrates that increased hand hygiene compliance by all health care workers can impact CLABSI rates. Both the increased hand hygiene compliance and resulting decreased CLABSI rates can be attributed to an action plan requiring consistent and strong application of four key areas.
Presentation Number 9-388 First Step to Reducing Infection Risk as a System: Evaluation of Infection Prevention Processes for 71 Hospitals Michelle M. Heavens RN, BSN, MHA, Clinical Excellence Director, Ascension Health; Carol Ratcliffe DNP, RN, CNOR, FACHE, Adjunct Faculty Graduate Program, Ida V Moffett School of Nursing, Samford University; Ann Hendrich PhD, RN, SVP Clinical Excellence, Ascension Health; Mohamad G. Fakih MD, MPH, Medical Director, St John Hospital and Medical Center BACKGROUND/OBJECTIVES: Healthcare-associated infections (HAIs) lead to significant morbidity and mortality. Hospitals can better focus their efforts if they identify specific areas for improvement to reduce risk. Ascension Health is one of 26 hospital engagement networks funded by the Centers for Medicare and Medicaid Services to address HAIs through “Partnership for Patients”. METHODS: We created a web-based survey of infection preventionists (IPs) at 71 Ascension Health hospitals to evaluate opportunities for improvement to prevent 4 HAIs. The survey of 96 questions addressed catheter associated urinary tract infection (CAUTI), central line associated blood stream infection (CLABSI), ventilator associated pneumonia (VAP), and surgical site infection (SSI). The survey focused on policies, practices, and outcomes evaluation. One IP from each hospital completed the survey. RESULTS: Facilities: Of the 71 hospitals, 26 had 100 beds, 20 had 101-300 beds, and 25 had >300 beds. 71 (100%) IPs completed the survey. The vast majority of hospitals had established policies for urinary catheter placement and maintenance (55/70, 78.6%), central venous catheter maintenance (68/71, 95.8%), and care for the mechanically ventilated patient (62/66, 93.9%). All IPs reported having policies for antisepsis of the operative site, the hands of the surgical team, and cleaning and disinfection of the environment. However, there was variation related to the healthcare worker (HCW) practice, and evaluation of competencies and outcomes. When addressing device need, 55/71 (77.5%) hospitals used a nurse driven evaluation of urinary catheter need, 26/71 (36.6%) had a team evaluation for central venous catheters on transfer out of intensive care, and 53/57 (93%) assessed daily ventilator support for continued need. Only 19/71 (26.8%) hospitals had annual nursing competencies for urinary catheter placement and maintenance, 29/ 71 (40.8%) for venous catheter maintenance, and 38/66 (57.6%) for appropriate surgical scrubbing. Root cause analysis was used to analyze events in 23/71 (32.4%) hospitals for CAUTIs, 40/ 71 (56.3%) for CLABSIs, 39/57 (68.4%) for VAP, and 30/66 (45.5%) for SSIs. CONCLUSIONS: Evaluating infection prevention policies and HCW practices help guide hospitals identify the target areas for improvement efforts. Our next steps include 1) implementing periodic evaluation of HCW’s competencies, 2) auditing practices and prompt feedback on performance, and 3) optimizing feedback on outcomes to the different stakeholders.
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013
2011 rates went from a high of 7.72/1000 vent days (May 2011) to 2.65/1000 vent days with a median rate of 3.1/1000 vent days. 2012 saw an overall decline from a high of 5.41/1000 vent days (Jan 2012) to 0.0/1000 vent days for seven (7) months out of eleven (11) with a median of 1.2/1000 vent days. (Figure 1) Additional non-measured benefits include the following: continual patient care during transport/ necessary testing and no change in nurse-patient ratio for the remaining critically ill patients in the ICU. LESSON LEARNED: Reduction of harm to patients related to VAP relies on new and innovative ways to improve current processes and redesign roles to meet the needs of the patients. Dedication to timely defect analysis by the team with cycles of change in processes result in a positive outcomes.
Presentation Number 9-387 A Quality Improvement Project on Hand Hygiene Compliance and Its Impact on Central Line Associated Blood Stream Infections Linda Johnson MSN, RN, CIC, Manager Infection Prevention and Control, University of Missouri Health Care; Paula Bullock M.Ed, MT(ASCP), CIC, Infection Control Professional, University of Missouri Health Care; Eileen Phillips BSN, RN, CIC, Infection Control Professional, University of Missouri Health Care; Cathy Schlotzhauer BSN, RN, CIC, Infection Control Professional, University of Missouri Health Care; Jaime Basnett BSN, RN, CIC, Infecion Control Professional, University of Missouri Health Care ISSUE: The risk of developing Central Line-Associated Bloodstream Infection (CLABSI) depends on several factors. Emphasis on hand hygiene and proper use of alcohol-based hand rubs is a critical intervention in minimizing healthcare associated infections (HAI) that is supported by the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) guidelines. The objective of this Quality Improvement Project was to improve the hand hygiene compliance among all health care workers and decrease the rate of CLABSI. PROJECT: An action plan was developed to improve hand hygiene compliance among the hospital staff. Cornerstones of this plan were education, compliance monitoring, product selection, and product accessibility. Re-education on the importance of proper hand hygiene was conducted. Additionally, covert monitoring (via observation per WHO recommendation) of staff compliance was performed. Observers immediately intervened with non-compliant staff and followed with written notification of non-compliance to supervisory personnel. After careful review of available scientific data, an 85% ethyl alcohol product (Sterillium Comfort GelÒ *) was selected as a hand antiseptic. Product accessibility issues were identified and resolved with relocation of dispensers and reinforcement of refilling procedures. When a clinical infection was suspected, the patient’s blood was cultured per hospital protocol. The CDC/National Healthcare Safety Network (NHSN) CLABSI surveillance definitions were used. RESULTS: Based on a Poisson regression model, there is a statistically significant correlation between hand hygiene (HH) compliance rate and CLABSI rate (p<0.0001). For this quality improvement project, the baseline for HH compliance rate was almost 70% and baseline for the CLABSI rate was 4.22 per 1,000 device days. After implementing a Central Line Bundle and hand hygiene education, the HH compliance rate increased to 90% with a corresponding decreased CLABSI rate of 1.13/1,000 device days (Apr09 e Mar11). After implementation of staff hand hygiene monitoring, selection of
S101
an 85% ethyl alcohol gel hand sanitizer, and improved sanitizer accessibility, the HH compliance rate increased further to 98% with a corresponding decrease in CLABSI rate to 0.42/1,000 device days (Mar11 e Feb12). LESSON LEARNED: This quality improvement project illustrates that increased hand hygiene compliance by all health care workers can impact CLABSI rates. Both the increased hand hygiene compliance and resulting decreased CLABSI rates can be attributed to an action plan requiring consistent and strong application of four key areas.
Presentation Number 9-388 First Step to Reducing Infection Risk as a System: Evaluation of Infection Prevention Processes for 71 Hospitals Michelle M. Heavens RN, BSN, MHA, Clinical Excellence Director, Ascension Health; Carol Ratcliffe DNP, RN, CNOR, FACHE, Adjunct Faculty Graduate Program, Ida V Moffett School of Nursing, Samford University; Ann Hendrich PhD, RN, SVP Clinical Excellence, Ascension Health; Mohamad G. Fakih MD, MPH, Medical Director, St John Hospital and Medical Center BACKGROUND/OBJECTIVES: Healthcare-associated infections (HAIs) lead to significant morbidity and mortality. Hospitals can better focus their efforts if they identify specific areas for improvement to reduce risk. Ascension Health is one of 26 hospital engagement networks funded by the Centers for Medicare and Medicaid Services to address HAIs through “Partnership for Patients”. METHODS: We created a web-based survey of infection preventionists (IPs) at 71 Ascension Health hospitals to evaluate opportunities for improvement to prevent 4 HAIs. The survey of 96 questions addressed catheter associated urinary tract infection (CAUTI), central line associated blood stream infection (CLABSI), ventilator associated pneumonia (VAP), and surgical site infection (SSI). The survey focused on policies, practices, and outcomes evaluation. One IP from each hospital completed the survey. RESULTS: Facilities: Of the 71 hospitals, 26 had 100 beds, 20 had 101-300 beds, and 25 had >300 beds. 71 (100%) IPs completed the survey. The vast majority of hospitals had established policies for urinary catheter placement and maintenance (55/70, 78.6%), central venous catheter maintenance (68/71, 95.8%), and care for the mechanically ventilated patient (62/66, 93.9%). All IPs reported having policies for antisepsis of the operative site, the hands of the surgical team, and cleaning and disinfection of the environment. However, there was variation related to the healthcare worker (HCW) practice, and evaluation of competencies and outcomes. When addressing device need, 55/71 (77.5%) hospitals used a nurse driven evaluation of urinary catheter need, 26/71 (36.6%) had a team evaluation for central venous catheters on transfer out of intensive care, and 53/57 (93%) assessed daily ventilator support for continued need. Only 19/71 (26.8%) hospitals had annual nursing competencies for urinary catheter placement and maintenance, 29/ 71 (40.8%) for venous catheter maintenance, and 38/66 (57.6%) for appropriate surgical scrubbing. Root cause analysis was used to analyze events in 23/71 (32.4%) hospitals for CAUTIs, 40/ 71 (56.3%) for CLABSIs, 39/57 (68.4%) for VAP, and 30/66 (45.5%) for SSIs. CONCLUSIONS: Evaluating infection prevention policies and HCW practices help guide hospitals identify the target areas for improvement efforts. Our next steps include 1) implementing periodic evaluation of HCW’s competencies, 2) auditing practices and prompt feedback on performance, and 3) optimizing feedback on outcomes to the different stakeholders.
APIC 40th Annual Conference j Ft Lauderdale, FL j June 8-10, 2013