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Reduction in Central Line Associated Bloodstream Infections across a Long-Term Acute Care Hospital System
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Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
Contingency Response Protocol has proven effective at reducing retest results that exceed validation criteria from 35% (2014) to 0% (2018). CONCLUSIONS: A comprehensive and compliant system WMP with a robust validation program and associated Contingency Response Protocol is an effective tool at mitigating Legionella risk as evidenced by the reduction in initial positive tests and positive retests.
Presentation Number QA-89 Reducing Surgical Site Infections in the Enhanced Recovery After Surgery Patient Population Kimberly Seymour CIC, MLS (ASCP) SM; Noreen Johnson RN, BSN, CIC, Texas Health Dallas BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based practice (EBP) inter-professional approach to improving care for the surgical patient. ERAS pathways include minimally invasive surgeries, pre-op nutritional support, intraoperative fluid management, and decreased opioid use with early mobilization, introduction of food, and gum chewing. Patient engagement is critical to achieving ERAS objectives. European countries have been implementing the concepts associated with ERAS for nearly 20?years. Benefits of ERAS innovative pathways are decreased length of stay, postop complications, infections, malnutrition, pain management and hospital readmission. METHODS: Surgical site infections (SSIs) are associated with an increased length of stay, morbidity, costs of care, and readmissions. An ERAS program was started at a large acute care, level II trauma facility in January 2017 to utilize evidence-based interventions to improve patient outcomes in elective colorectal surgery patients. RESULTS: From 1st to 4th Quarter 2017, there was a steady decrease in the surgical site infection rate in ERAS colon procedures from 6% to 2%. While a slight increase was noted in the first two quarters of 2018, the overall Colon SSI Standardized Infection Ration (SIR) dropped from 1.867 in the 1st Quarter of 2017 to 0.656 in the 2nd Quarter of 2018. CONCLUSIONS: The ERAS program improved the outcomes of patients requiring a colon procedure by improving pain control and return of gastric motility and reducing SSI and length of hospital stay. Interventions that may have contributed to the reduced colon SSI SIR include changes in practice by colon surgeons (separate closure trays, oral antibiotics, separate staplers e.g.) and implementation of an evidenced-based ERAS program.
Presentation Number QA-90 Reduction in Central Line Associated Bloodstream Infections across a LongTerm Acute Care Hospital System Mandy M. Bodily-Bartrum DNP, MPH, RN, CIC, FAPIC, Vibra Healthcare BACKGROUND: Long-term acute care hospitals (LTACHs) have faced challenges with central line associated bloodstream infections (CLABSIs). Central lines are common among patients in this setting, increasing risk for CLABSI. The goal of this research is to determine whether CLABSI reduction initiatives have resulted in a decrease in CLABSI infections. METHODS: The LTACH system has 26 hospitals, geographically dispersed across the country. Since 2015, the healthcare system has implemented more consistent reviews of central line necessity,
increased education for Infection Preventionists about identifying infections, standardized central line dressing kits, and more robust antimicrobial stewardship committees within each hospital. The hospitals utilize National Healthcare Safety Network to submit identified CLABSIs. CLABSI Standardized Infection Ratios (SIR) and central line Standardized Utilization Ratios (SUR) were reviewed at a system level from 2015 to 2018. RESULTS: When comparing 2015 to September 2018, the system has had 145 fewer CLABSI infections identified, an estimated cost savings of $2,672,640. The SIR in 2015 was 1.57, whereas the SIR for 2018 is 1.18, a decrease of 39%. In 2015 the system had 106 more CLABSIs than predicted, whereas in 2018, the system has had 23 more than predicted. In 2018, the system used 63,252 fewer lines when compared to 2015. In 2015, the system used 47,000 more lines than expected, as compared to 9,936 more than expected in 2018. The SUR in 2015 was 1.38 and in 2018 the SUR was 1.10, which indicates a 28% reduction in central line usage. CONCLUSIONS: Scrutiny and education on central line usage, in addition? to more education to IPs and standardized dressing change kits have results in significant decreases in infection identified throughout the LTACH system. While the system still has room for improvement in reducing CLABSI, standardization of processes has shown a decrease in CLABSIs and thus better quality care for patients.
Presentation Number QA-91 A Multi-Disciplinary Initiative to Streamline and Expedite the Pulmonary Tuberculosis Rule Out Process Jos Cooper-Sterling RN, MPH, CIC, Stanford Healthcare; Alexandra S. Madison MPH, CIC, FAPIC, Stanford Healthcare; Sheryl Michelson RN, MS, BC, Stanford Healthcare; Norina Agulo BS, RRT, RCP; Dave Scott AS, RRT, RCP; Marisa Holubar MD, MPH; Lucy Tompkins MD, PhD; John Hahesy; Kristen Merriman BACKGROUND: Multi-factorial problems were encountered in ruling patients out for Tuberculosis in a healthcare facility located in one of the highest incidence areas in the United States. These problems led to increased time spent in Airborne Isolation as well as extended in-patient stays. The objective of the team was to streamline the process through education, protocol change, increased communication and collaboration, and real-time resolution of barriers. Other objectives included decreasing sputum collection time to under 20?hours and to decrease the length of time spent in negative airflow by 20%. METHODS: A Task Force was convened to review the challenges of efficiently ruling out patients with risk factors for Tuberculosis. The Tuberculosis log was reviewed for 3 months to determine the duration of time spent in Airborne Isolation rooms and how long it took for the completion of specimen collection. The group developed/ implemented a combination of structured/unstructured education, protocol changes, creating a physician order-set, standard work and real-time fixes to reinforce practice change. Charting of sputum collection time and discontinuation of Airborne Isolation in the electronic medical record was utilized to determine percentage of change. RESULTS: Results indicated that there was an improvement in the rule out process over a 15-month period, and increased timely discontinuation of Airborne Isolation. Results demonstrated an increase from 31.17% to 70% in the completion of specimen collection under 20?hours. The average number of days spent in Airborne Isolation decreased from 3.09?days to 2.35 days(24%).
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019
Poster Abstracts / American Journal of Infection Control 47 (2019) S15−S50
Contingency Response Protocol has proven effective at reducing retest results that exceed validation criteria from 35% (2014) to 0% (2018). CONCLUSIONS: A comprehensive and compliant system WMP with a robust validation program and associated Contingency Response Protocol is an effective tool at mitigating Legionella risk as evidenced by the reduction in initial positive tests and positive retests.
Presentation Number QA-89 Reducing Surgical Site Infections in the Enhanced Recovery After Surgery Patient Population Kimberly Seymour CIC, MLS (ASCP) SM; Noreen Johnson RN, BSN, CIC, Texas Health Dallas BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based practice (EBP) inter-professional approach to improving care for the surgical patient. ERAS pathways include minimally invasive surgeries, pre-op nutritional support, intraoperative fluid management, and decreased opioid use with early mobilization, introduction of food, and gum chewing. Patient engagement is critical to achieving ERAS objectives. European countries have been implementing the concepts associated with ERAS for nearly 20?years. Benefits of ERAS innovative pathways are decreased length of stay, postop complications, infections, malnutrition, pain management and hospital readmission. METHODS: Surgical site infections (SSIs) are associated with an increased length of stay, morbidity, costs of care, and readmissions. An ERAS program was started at a large acute care, level II trauma facility in January 2017 to utilize evidence-based interventions to improve patient outcomes in elective colorectal surgery patients. RESULTS: From 1st to 4th Quarter 2017, there was a steady decrease in the surgical site infection rate in ERAS colon procedures from 6% to 2%. While a slight increase was noted in the first two quarters of 2018, the overall Colon SSI Standardized Infection Ration (SIR) dropped from 1.867 in the 1st Quarter of 2017 to 0.656 in the 2nd Quarter of 2018. CONCLUSIONS: The ERAS program improved the outcomes of patients requiring a colon procedure by improving pain control and return of gastric motility and reducing SSI and length of hospital stay. Interventions that may have contributed to the reduced colon SSI SIR include changes in practice by colon surgeons (separate closure trays, oral antibiotics, separate staplers e.g.) and implementation of an evidenced-based ERAS program.
Presentation Number QA-90 Reduction in Central Line Associated Bloodstream Infections across a LongTerm Acute Care Hospital System Mandy M. Bodily-Bartrum DNP, MPH, RN, CIC, FAPIC, Vibra Healthcare BACKGROUND: Long-term acute care hospitals (LTACHs) have faced challenges with central line associated bloodstream infections (CLABSIs). Central lines are common among patients in this setting, increasing risk for CLABSI. The goal of this research is to determine whether CLABSI reduction initiatives have resulted in a decrease in CLABSI infections. METHODS: The LTACH system has 26 hospitals, geographically dispersed across the country. Since 2015, the healthcare system has implemented more consistent reviews of central line necessity,
increased education for Infection Preventionists about identifying infections, standardized central line dressing kits, and more robust antimicrobial stewardship committees within each hospital. The hospitals utilize National Healthcare Safety Network to submit identified CLABSIs. CLABSI Standardized Infection Ratios (SIR) and central line Standardized Utilization Ratios (SUR) were reviewed at a system level from 2015 to 2018. RESULTS: When comparing 2015 to September 2018, the system has had 145 fewer CLABSI infections identified, an estimated cost savings of $2,672,640. The SIR in 2015 was 1.57, whereas the SIR for 2018 is 1.18, a decrease of 39%. In 2015 the system had 106 more CLABSIs than predicted, whereas in 2018, the system has had 23 more than predicted. In 2018, the system used 63,252 fewer lines when compared to 2015. In 2015, the system used 47,000 more lines than expected, as compared to 9,936 more than expected in 2018. The SUR in 2015 was 1.38 and in 2018 the SUR was 1.10, which indicates a 28% reduction in central line usage. CONCLUSIONS: Scrutiny and education on central line usage, in addition? to more education to IPs and standardized dressing change kits have results in significant decreases in infection identified throughout the LTACH system. While the system still has room for improvement in reducing CLABSI, standardization of processes has shown a decrease in CLABSIs and thus better quality care for patients.
Presentation Number QA-91 A Multi-Disciplinary Initiative to Streamline and Expedite the Pulmonary Tuberculosis Rule Out Process Jos Cooper-Sterling RN, MPH, CIC, Stanford Healthcare; Alexandra S. Madison MPH, CIC, FAPIC, Stanford Healthcare; Sheryl Michelson RN, MS, BC, Stanford Healthcare; Norina Agulo BS, RRT, RCP; Dave Scott AS, RRT, RCP; Marisa Holubar MD, MPH; Lucy Tompkins MD, PhD; John Hahesy; Kristen Merriman BACKGROUND: Multi-factorial problems were encountered in ruling patients out for Tuberculosis in a healthcare facility located in one of the highest incidence areas in the United States. These problems led to increased time spent in Airborne Isolation as well as extended in-patient stays. The objective of the team was to streamline the process through education, protocol change, increased communication and collaboration, and real-time resolution of barriers. Other objectives included decreasing sputum collection time to under 20?hours and to decrease the length of time spent in negative airflow by 20%. METHODS: A Task Force was convened to review the challenges of efficiently ruling out patients with risk factors for Tuberculosis. The Tuberculosis log was reviewed for 3 months to determine the duration of time spent in Airborne Isolation rooms and how long it took for the completion of specimen collection. The group developed/ implemented a combination of structured/unstructured education, protocol changes, creating a physician order-set, standard work and real-time fixes to reinforce practice change. Charting of sputum collection time and discontinuation of Airborne Isolation in the electronic medical record was utilized to determine percentage of change. RESULTS: Results indicated that there was an improvement in the rule out process over a 15-month period, and increased timely discontinuation of Airborne Isolation. Results demonstrated an increase from 31.17% to 70% in the completion of specimen collection under 20?hours. The average number of days spent in Airborne Isolation decreased from 3.09?days to 2.35 days(24%).
APIC 46th Annual Educational Conference & International Meeting| Philadelphia, PA | June 12-14 2019