Healthcare- associated Infections in North Carolina: A Statewide Discussion

Transcription

1 Healthcare- associated Infections in North Carolina: A Statewide Discussion 1

2 State Stakeholders 2

3 Agenda Background Data limitations Data review Prevention activities Q&A 3

4 Goal To discuss HAI prevention activities and needs across NC: 1. How can we use the publicly reported data to help drive HAI rates down further in NC? Internally, inside hospitals? Externally, in the state? 2. How can the state- level stakeholders better assist hospitals in their HAI prevention efforts? 4

5 Why? Right thing to do for all of us Part of all- cause harm prevention HAIs are very costly 5

6 Cost of HAIs for NC Hospitals BIG Numbers! Anderson D., et al. Statewide costs of healthcare- associated infections: estimates for acute care hospitals in North Carolina. AJIC. Vol 41, Issue 9; Sept

7 Background State of NC passed public reporting legislation in 2011: Includes same healthcare- associated infections (HAIs) as CMS CLABSI, CAUTI, and two SSIs: HYST and COLO, led the way Lab ID C. diff and MRSA reporting to follow First public reports made available in 2012 First 2012 annual public report published April 2013 NC state- wide stakeholders came together to coordinate a state- level discussion on how we can use the data for the betterment of our hospitals and all North Carolinians. 7

8 Leveraging the Data Limitations must be acknowledged: 1. Current public reporting does not represent the full spectrum of HAIs. 2. Data are preliminary and are non- validated. 3. NHSN definitions are complex: involve tracking and linking information from multiple systems, interpretation and entry by multiple staffs; may require subjective interpretation, etc. 4. Data are self- reported. 5. Data in snap shots right now. 6. NHSN reference datasets (baselines) being used to calculate predicted # of HAIs are old: 2009 for CAUTI and for CLABSI and SSI. 8

9 What are SIRs? Standardized Infection Ratio (SIR) A summary measure used to track HAIs over time Adjusts for the fact that facilities treat different types of patients Indirect standardization method Comparison to standardized population via national, historical baseline data 9

10 How are SIRs calculated? SIR = Observed # of HAIs Expected (Predicted) # of HAIs Observed # of HAIs: Number of events (HAIs) you enter into NHSN Expected (Predicted) # of HAIs: National NHSN baseline data Baseline data for CAUTI SIR is 2009 NHSN aggregate data from June 2011 AJIC report. Baseline period for CLABSI and SSI SIRs is NHSN aggregate data from December 2009 AJIC report. 10

11 SIR Data Interpretation SIR Values SIR = 1: Observed number of HAIs the same as expected number (i.e. the national average) SIR < 1: Fewer HAIs than expected SIR > 1: More HAIs than national average SIR data for device- related infection not shown for facilities with < 50 device days or < 20 procedures No SIR calculated if Expected (Predicted) # of HAIs < 1 11

12 SIR Resources The 2009 through 2011 state- specific SIR reports by CDC can be found at: nhsn_statereports.html Additional SIR Q&A: QA_stateSummary.html#a6 12

13 CAUTI: 1-99 Beds 13

14 CAUTI: Beds 14

15 CAUTI: Beds 15

16 CAUTI: 400+ Beds 16

17 CAUTI: Primary Med School Affiliation 17

18 CLABSI: 1-99 Beds 18

19 CLABSI: Beds 19

20 CLABSI: Beds 20

21 CLABSI: 400+ Beds 21

22 CLABSI: Primary Med School Affiliation 22

23 Colon Surgery: 1-99 Beds 23

24 Colon Surgery: Beds 24

25 Colon Surgery: Beds 25

26 Colon Surgery: 400+ Beds 26

27 Colon Surgery: Primary Med School Affiliation 27

28 Abd. Hysterectomy: 1-99 Beds 28

29 Abd. Hysterectomy: Beds 29

30 Abd. Hysterectomy: Beds 30

31 Abd. Hysterectomy: 400+ Beds 31

32 Abd. Hyst: Primary Med School Affiliation 32

33 State- level HAI Prevention Activities Highlights APIC- NC CCME CHS HEN DICON LifePoint HEN NC SPICE NoCVA HEN/NC Quality Center Premier HEN 33

34 Both organizations have as part of their mission to improve patient safety in all healthcare settings through evidence- based infection prevention education, consultation, advocacy, and research. In addition, both support infection prevention throughout the state by promoting and facilitating Infection Preventionists networking, shared learning, and professional development.

35 CCME 14 Hospitals in NC working to reduce CLABSI, CAUTI, SSI and CDI. Provide Hospitals with Evidence- based tools EducaHon Technical assistance AnalyHcal review of data from NHSN databases o Quarterly graphical data provided. CCME Quality Improvement Model o CollaboraHon and consulhng o Monthly coaching calls o Quarterly site visits o Quarterly educahonal webinars/teleconferences o Yearly in- person learning sessions o IdenHfy champions as mentors

36 DICON Services 42 Hospitals and Surgery Centers in 5 states (NC, VA, SC, GA, FL) Affiliated hospitals range from 38 to 638 beds with mean of 175, total beds > 9,000 and total ICPs > 50. o Does not include Duke Hospital for benchmarking purposes Time- trended surveillance informahon to hospitals and surgery centers o GOAL: MoHvate HCPs to do the right thing Provide hospitals and surgery centers with informahon o Best prachces o Best technology o EducaHonal programs on infechon control

37 DICON Services (conhnued) Regular visits to site by liaison ICP for hands on achvity o Agenda set by local IP AnalyHcal review of data from DICON databases o Ongoing review of data o Early detechon of potenhal problems o Semi- annual benchmarking reports provided o Comparison of individual surgeon risk- adjusted SSI rate to other surgeons Outbreak inveshgahons and special projects performed at hospital s request Assist hospitals with gathering data for mandatory reporhng for state and CMS purposes. DICON Model is effechve 1,2 1- Kaye et al. ICHE 2006;27: Anderson et al. ICHE 2011;32:315.

38 Hospital- Acquired UTI Reduction Structure Monthly webinars Monthly coaching calls 1:1 vs. small group On- site validation visits Tools Gap analysis/ Action Plan tool Audit tools Process Boards TeamSTEPPS tools Things we learned Aseptic technique Securement devices Appropriate pericare Removal of unnecessary catheters All- inclusive insertion kits

39 North Carolina- Virginia (NoCVA) HEN HAI Learning Network: Education- focused: technical and adaptive strategies using CUSP model (leadership, science of safety, learning from defects, teamwork and communication, reliability) CAUTI, CLABSI, VAE/VAP, SSI Horizontal and vertical prevention strategies NCQC planning a MDRO/C.diff collaborative for

40 CLABSI >25% Improvement >800 fewer cases Top quartile at ZERO since Jan 2012 Coaching calls Knowledge transfer Ex. State line day and review necessity during daily rounds; Chlorhexidine baths; Ultrasound guidance for placement SSI Measuring colons and hysterectomies only 1154 fewer cases Top quartile at ZERO since Jan 2013 Johns- Hopkins SUSP Work upstream to find patients at risk before surgery Adding additional areas of focus: Hip or Knee (project JOINTs) CAUTI Greatest opportunity 886 fewer cases Trend line has been flat Top quartile at ZERO since Jan 2012 On the CUSP (ED/ OR) Coaching Calls Onsite Technical Assistance Ex: Documented insertion rationale; systems for prompt removal when indications no longer apply; Nurse driven protocol; Insertion technique audited; urinary catheter days tracked

41 CHS HEN 41

42 So Significant resources and hard work are going into collecting, analyzing and reporting the data. The data for each hospital tells a story about that hospital. We need to leverage it as much as possible for the good. How can we do this? 42

43 Discussion Questions 1. How can we use publicly reported data to help drive HAI rates down in NC? Inside our hospitals? In the state? 43

44 Questions 2. How can the state- level stakeholders better assist hospitals in their HAI prevention efforts? 44

45 Contact Information Stakeholder Contact Person Phone Website APIC- NC Jayne Lee, BSN, MPH, CIC APIC- NC President CCME Chrystal Adams, RN Carolinas Health System HEN Martha Alspaugh shealthcare.org DICON Polly Padgette, BSN, CIC LifePoint HEN Joi Fox NC Division of Public Health HAI Prevention Program Connie Jones, RN, CIC cd/index.html NC Quality Center NC SPICE Shelby Lassiter, BSN, RN, CIC Kirk Huslage, MSN, MSPH,BSN, RN, CIC Premier HEN Monica Barrington erinc.com safety/topics/hai/hai- Partnership- for- patients.jsp 45