2014 Partnership in Prevention Award. November 21, :00-1:00PM EST. Introduction

Transcription

1 2014 Partnership in Prevention Award November 21, :00-1:00PM EST Introduction Don Wright, MD, MPH Deputy Assistant Secretary for Health (Disease Prevention and Health Promotion) U.S. Department of Health & Human Services 1

2 Today s Agenda Introduction Keynote Remarks Partner Remarks Don Wright, MD, MPH Deputy Assistant Secretary for Health (Disease Prevention and Health Promotion) U.S. Department of Health and Human Services Karen B. DeSalvo, MD, MPH, MSc Acting Assistant Secretary for Health U.S. Department of Health and Human Services Katrina Crist, MBA Chief Executive Officer Association for Professionals in Infection Control and Epidemiology (APIC) Anthony Harris, MD, MPH President-Elect Society for Healthcare Epidemiology of America (SHEA) Award Announcement Winner Presentation Karen B. DeSalvo, MD, MPH, MSc Key Interventions and Strategies Results and Lessons Learned Keynote Remarks Karen B. DeSalvo, MD, MPH, MSc Acting Assistant Secretary for Health U.S. Department of Health & Human Services 2

3 Healthcare-Associated Infections (HAI) Definition Healthcare-Associated Infections are infections that people acquire while receiving treatment for another condition in healthcare settings: Inpatient Hospitals Ambulatory settings Long-term care facilities Any healthcare setting where people receive care HAI Burden At any given time, 1 in 25 U.S. hospital patients has a healthcare-associated infection. $33 billion inpotentiallypreventable health care costs annually. SOURCE: 3

4 HAI Action Plan HAIs Decline Nationally Standardized infection ratio (SIR) Decline in SIR for CLABSI HHS Action Plan and Agency Priority Goal 2013 CLABSI Target Healthy People 2020 CLABSI Target Central Line-Associated Bloodstream Infections (CLABSI)* Infections per 100,000 persons Decline in MRSA Incidence HHS Action Plan and Agency Priority Goal 2013 MRSA Target Methicillin-Resistant Staphylococcus aureus Source: *Hospital setting Healthy People 2020 MRSA Target 4

5 National Awards Recognition Program Partnership in Prevention Award Partnership between HHS, APIC and SHEA Recognizes single multidisciplinary team Katrina Crist, MBA CEO Association for Professionals in Infection Control and Epidemiology Vision: Healthcare without infection Mission: Create a safer world through prevention of infection APICInfectionPreventionandYou 5

6 Who we are and what we do Leading professional association for infection preventionists (IPs) 15,000+ members with backgrounds in nursing, medical technology, epidemiology, microbiology, public health, medicine 117 Chapters; 3 are international Members work across spectrum of care: hospitals, ambulatory care, public health, long-term care APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Core Programs Education & Professional Development: - Face-to-face and online education - Annual Conference - Infection prevention courses Public Affairs & Advocacy - Regulatory comment letters - Collaborations with key stakeholders, e.g., Partnership in Prevention Award Practice Guidance & Research - American Journal of Infection Control - Implementation Guides - Texts and manuals 6

7 The ABC s of Antibiotics infographic Builds on Infection Prevention and You campaign Engages consumers in prevention of antibiotic resistance Anthony Harris, MD, MPH University of Maryland School of Medicine President-Elect, SHEA The Society for Healthcare Epidemiology of America SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. 7

8 The Society for Healthcare Epidemiology of America (SHEA) SHEA is a professional society representing physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at Key SHEA Initiatives Education Policy Guidelines SHEA Research Network Infection Control and Hospital Epidemiology (ICHE) Partnership in Prevention Award SHEA Epi Competition SHEA Education & Research Foundation 8

9 Eligibility Criteria Candidate team must include: Executive level leadership Multidisciplinary partnership, Evidence-based interventions, Sustained improvement The 2014 Partnership in Prevention Award Announcement 9

10 The heart and science of medicine. UVMHealth.org/MedCenter Reducing Healthcare-Associated Infections in an Academic Medical Center: An Organizational Priority W. Kemper Alston, MD, MPH, Medical Director & Epidemiologist Sally Hess, MPH, CIC, Manager, Infection Prevention Carolyn Terhune, MT(ASCP), CIC, Infection Preventionist Anna Noonan, RN, Vice President, Jeffords Institute for Quality University of Vermont Medical Center Vermont s only Academic Medical Center Part of The University of Vermont Health Network a 4 hospital system in VT and NY 30+ patient care sites and 100 outreach sites in VT and NY Level 1 Trauma Center, Level III NICU, 58-bed Children s Hospital 562 licensed beds (excluding nursery); 419 staffed 7,000+ employees Volumes: 50,364 inpatient and outpatient admissions; 2,175 births; 60,484 emergency department visits; 1,145,942 physician encounters 580 board-certified employed physicians, 300 residents, 60 fellows 58 Medical Specialties 342 active research projects 10

11 2008: Getting to Zero Becomes an Organizational Priority Supported by Senior Leadership Infection Prevention Advocate program Focused education for over 120 direct care providers Implementation of local IP improvement projects Environmental Services: Practice change, monitoring and feedback Enhanced surveillance and internal reporting with priority areas identified Graduate medical education Priority Areas Identified Total knee and hip replacement surgical site infections (SSI) Orthopedic spinal fusion SSI Central line-associated bloodstream infections (CLABSI) in medical intensive care Central line access-related bloodstream infections (CL- ARB) in outpatient dialysis centers CLABSI in neonatal intensive care 11

12 Total Hip and Knee Joint Replacement PI Team Multidisciplinary Team Orthopedic surgeons Hospital Epidemiologist Clinical pharmacist Ortho inpatient nurse manager Outpatient clinic staff Perioperative services Ortho OR clinical specialist Infection prevention Quality Consultant: Jeffords Institute for Quality Clinical Practice and Interventions for Total Knee and Hip Replacement Preoperative improvements: Hemoglobin Hemoglobin A1C Dental evaluation MRSA/MSSA pre-operative screening & decolonization Risk-adjusted clot prevention program Intraoperative improvements: WHO checklist Reduced OR traffic Enhanced teamwork; shorten cases and avoid delays Standardized dressing product Sterile hoods for surgical team 12

13 Total Hip and Knee Joint Replacement Period (18 months) Baseline (1/2009-6/2010) Achievement (10/2011-3/2013) 12 Month Update (4/13 3/14) Procedure Code Procedure Count Infection Count Number Expected SSI SIR SIR p-value 95% CI HPRO , KPRO , HPRO , KPRO , HPRO , KPRO , Orthopedic Spinal Fusion SSI Team Multidisciplinary Team Orthopedic surgeons Anesthesiologist Central Sterile Reprocessing manager Environmental Services director Hospital Epidemiologist Industrial Hygienist Infection Prevention manager Orthopedic inpatient nurse manager Orthopedic clinical care coordinator Surgical assistant Quality Consultant: Jeffords Institute for Quality 13

14 Clinical Practice and Interventions for Orthopedic Spinal Fusions Improving preoperative care: Preoperative patient education MRSA/MSSA pre-operative screening and decolonization Preoperative chlorhexidine gluconate bathing Improving surgical processes and the environment: Surgeon initiated triple play procedure pause for complex cases: Antibiotic re-dose, glove change and wound irrigation every 3 hours Vancomycin powder prior to closure and mini-vacuum dressings Reduced OR traffic Monthly air quality monitoring CSR use of ATP methods to verify instrument reprocessing Improved disinfection of the OR environment Orthopedic Spinal Fusion SSI Outcomes Period SSIs Cases SSI Rate (%) Baseline (1/ /2011) Achievement (12/2011-5/2013) month UPDATE ( 6/13 7/14)

15 CLABSI PI Initiative in the Medical ICU Multidisciplinary MICU Rapid Redesign Team Critical care physicians (Medicine & Anesthesia) Infection Prevention Advocates MICU nurses Nurse Educator Manager Director Supply chain Simulation Lab educator Simulation Lab leadership VP of Quality Vascular access nurses Infection Prevention Quality Consultant: Jeffords Institute for Quality CLABSI PI Initiative in the Medical ICU: Clinical Interventions & Practice Changes Central line insertion kit standardized Simulation lab training Insertion checklist in electronic medical record Ultrasound-guided placement Daily chlorhexidine gluconate (CHG) bathing Daily assessment of need Weekly rounds Monthly data to team and leadership Nursing education care & maintenance bundle 15

16 CLABSI PI Initiative in the Medical ICU: Outcomes Year Infections Number Expected Central Line Days NHSN SIR NHSN SIR p-value NHSN SIR 95% CI , , , , H , Month Update (7/2013 6/ , CL-ARB PI Initiative in Outpatient Hemodialysis Team members representing six outpatient centers: Infection Prevention Advocates Dialysis nurses Dialysis technicians Infection Prevention Manager Nurse Manager Assistant Nurse Managers Nurse Educator Nephrologist Hospital Epidemiologist 16

17 Clinical Practice Interventions in Outpatient Dialysis Participation in CDC Dialysis BSI Prevention Collaborative CDC Core interventions Education and monitoring of hand hygiene Standardization and monitoring of aseptic practices during catheter care and vascular access Enhanced catheter hub disinfection/cleaning method Use of antimicrobial ointment at catheter exit sites Participation in Fistula First initiatives Patient education Surveillance with feedback of cases and rates Dialysis CL-ARB Outcomes 17

18 CLABSI PI Initiative in the Neonatal ICU NICU Quality Improvement Committee NICU Medical Director Infection Preventionist NICU nurses Nurse Educator Nurse Manager Physicians (attendings, fellows and residents) Quality Consultant: Jeffords Institute for Quality Infection Prevention Advocates CLABSI PI Initiative in the Neonatal ICU Interventions and Practice Changes Monthly report out on progress at NICU Quality Committee Standardized central venous catheter (CVC) practices implemented: Insertion checklist Daily assessment Electronic health record prompt to remove catheter based on feeding volume 24 hr. catheter tubing change, experienced nurses only Enhanced nursing education and competency for CVC care 18

19 CLABSI Outcomes in the NICU Period Baseline (1/2009-9/2010) Achievement (10/2010-3/2013) 12 Month Update (4/2013 3/2014 Months Infections Number Expected Central Line Days NHSN SIR NHSN SIR p-value NHSN SIR 95% CI , , , Keys to Our Success Senior leadership commitment Infection Prevention and Jeffords Institute for Quality collaboration Implementation of evidence-based practices Engagement and education of direct care providers Use of surveillance data to drive improvement Monitoring and feedback of compliance with best practice over time 19

20 Infection prevention is the core of our organization s quality and safety culture and is integral to advancing high reliability across our system. UVMHealth.org/MedCenter UVMHealth.org/MedCenter Contact Information: Sally.Hess@vtmednet.org or Infectionprevention@vtmednet.org 20

21 Roundtable Discussion If you have any questions you would like to pose to the presenters, please type it into the Q&A window on the left. We will address as many questions as we can in the time allotted. Thank You to Our Partnership in Prevention Co-Sponsors: U.S. Department of Health and Human Services Association for Professionals in Infection Control and Epidemiology Society for Healthcare Epidemiology of America 21