MMI 408 Spring 2011 Group 1 John Wong Statement of Work for Infection Control Systems Monday, April 11, 2011
Table of Contents 1 Background... 3 2 Project Objectives... 4 3 Scope... 5 3.1 Included... 5 3.2 Excluded... 6 4 Deliverables... 7 5 Major Milestones... 10 6 Roles and Responsibilities... 11 7 References... 12 2
1 Background Healthcare Associated infection (HAI), has longed been a persistent problem in hospitals in USA and in other countries around the world. According to the Department of Health and Human Services (HHS) Action Plan to Prevent Healthcare Associated Infections, in USA during the year 2002 there were: - 1.7 million infections - 99,000 associated deaths - 1 out of 20 patients (5%) acquire an HAI - $26 to $33 billion in excess healthcare costs (HHS, 2009) A study by Centers for Disease Control and Prevention (CDC) in 1985 has shown the effect of adopting infection control efforts to actively reduce infections by 32%. (Stevenson et al, 2004). Similarly, hospitals in other countries have experienced similar or even worse infection rates, and the reduction in infection by the adoption of an effective infection control program. For example, in Switzerland, the rate of nonsocomial infection in a local hospital was 11.7%. The infection rate was reduced by 42% after an intervention program was introduced (Ebnother et al, 2008). Even though patients quality outcomes and well beings have longed been our hospital s prerogatives, we still fall into the said statistics whereby we have been experiencing a long history of nonsocomial infections and subsequent deaths among our patients. In the past, we have not addressed this particular problem as our top priority because, similar to what was reported in Mears (Mears, 2008), it is difficult to factor into our annual budget the cost saving associated with the prevention of HAI, and that we are more concerned in reducing the overall costs of our hospital s expenses. However, a recent article put the costs associated with each HAI infected patient to be at around $43,000 (Stibich, 2010), which in our hospital of 300 beds, and a 5% infection rate, that amount to quite a substantial cost to our hospital. Even so, financial impact should not be our sole consideration of an infection control program. Moreover, the quality of our deliverable care, the outcomes and well beings of our patients, and the reputation of our hospital and staff, are all at risk if we fail to take into action a comprehensive program that can help with the prevention and control of infection in our hospital. 3
2 Project Objectives As we mentioned in the previous section, the quality of life, the outcomes and well beings of our patients, the hospital s reputation, and the financial costs, are all important reasons that we should implement an infection control program. Given the fact that CMS has recently announced that it will stop paying hospitals for nosocomial infections, our hospital must come up with a strategy to explore and implement an infection control system as soon as possible. Specifically, six categories of infections made up the majority of HAI related incidents: surgical site infections (SSI), central line-associated bloodstream infections (CLABI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and infections associated with Clostridium difficile (C diff) and methicillin-resistant Staphylococcus aureus (MRSA) (HHS, 2009). Following the recommendation by various articles and published papers, such as the CDC s 1985 study on the efficacy of nosocomial infection control, the action plan by the Society for Healthcare Epidemiology of America (SHEA) in 1998, etc., the list of preventive measures and programs can be summarized as follow (Fraser et al, 2010), (Mears et al, 2008), (Stevnson et al, 2004), (Humphreys, 2010): - Surveillance of nosocomial infections - Capacity to detect and control outbreaks - Written policies for infection control and prevention - Collaboration with employee health programs - Ongoing education programs - Adequate human resources of hospital epidemiologist, ICP, etc. - Adequate computer and clinical microbiology laboratory support - Good compliance with recommendations on intravascular catheter care - Patient infection identification, and isolation - Better facilities with more space between patients - Improvements in hospital environment decontamination - More rapid diagnostics with earlier infection detection Our ultimate goal will be to device specific programs and technology that can allow us to implement the above stated objectives. As we see from our objectives, the list of proposed action is quite comprehensive. To define specific, measureable and attainable goals, we will focus on specific technology in our first year of implementation of our infection control program. We will adopt a multi stage roll out program for the rest of the objectives to be implemented in subsequent years. We will define our performance measurement as outlined in the action plan for HAI prevention and control by HHS. The specific 5 years prevention target for the various HAI s is as follow (HHS, 2009): 4
1. CLABSI: CLABSI per 1,000 device days by ICU and other locations reduced by 75% 2. C diff: 30% reduction in the case rate per patients days 3. CAUTI: 25% reduction in the number of symptomatic UTI / 1000 urinary catheter days 4. MRSA: 50% reduction rate of all healthcare associated invasive MRSA infections 5. SSI: Median deep incision and organ space infection rate at or below the current NHSN 25 th percentile In accordance with the recommended reduction, we want to set a higher bar for our hospital to attain. More specifically, by the end of the first year of the deployment of our infection control system, our goal is to reduce HAI in our hospital by 50%. 3 Scope 3.1 Included Based on the list of recommended actions as outlined in section 2, the following is what we will be doing in the first year of our infection control program. Requirement Patients infection identification and tracking, with optimal spaces allocation Real time monitoring and surveillance of air quality to control air borne infection and rapid detection of organisms Computer resources with efficient knowledge base for retrieval and data mining functionality for effective performance measurement and improvement Capacity to control infection outbreaks and decontamination standard operating procedures Voluntary disclosure of HAI incidents Agreed Solution Patient Infection Identification and Bed Management System Infection Surveillance System, Infection collection and real time pathogen analysis System Infection Data Repository and Business Intelligence Reporting System Infection Elimination (Disinfection) System with air sterilization units Reporting of HAI incident to National Data Collection Agencies 5
3.2 Excluded The following items are what we will be doing in subsequent years in the rollout of our multi-year infection control program: - Personal hygiene monitoring system (e.g. surveillance of hand washing routines by employees) - Revised employee health programs and code of conduct - Revised catheter equipment handling and usage procedures - Clinical Laboratory support - Revised standard operating procedures on the decontamination of infected environment - Updated infrastructures and equipment to minimize surface contamination (e.g. keyboards, door handles, toilet seats, cloths) - Revised cleaning routines - Human resources acquisition and capacity planning for epidemiologists and ICPs 6
4 Deliverables Deliverable Responsible Acceptance Criteria Due Date Approver High level requirements document gathered from all stakeholders for each of our stated scope Round robin in person interviews with CFO, CMO, CNO, ICP, CIO on written standardized pre-determined interview forms 7/1/2011 CIO, CMO, CNO, ICP, CFO, CEO Prioritize List of the various requirements Signature approval by each stakeholders on the agreed upon ranking 7/15/2011 CIO, CMO, ICP Existing workflow Visio diagram Development of a Visio diagram to capture the existing workflow with the availability of our current infection control program 7/15/2011 CIO, CMO, CNO, ICP Future workflow Visio diagram Development of a Visio diagram to capture the future workflow with the implementation of our proposed infection control program 7/15/2011 CIO, CMO, CNO, ICP High level Cost and Benefit Analysis (estimation of the cost of implementation of such programs (in house development vs commercial applications (COTS)) Senior Financial and Senior IT Architect High level cost estimates of various alternatives in the implementation of our proposed infection control program 8/1/2011 CIO, CFO A list of 5 potential vendors with solution that can meet the stated requirements Senior IT Architect Selection of 5 vendors with high level strength and limitation of each vendor s product 8/1/2011 CIO, CFO RFI Signed Senior Contract RFI to be signed off by Legal and Contract team 8/1/2011 CIO, CFO 7
Evaluation of information obtained from the vendors Senior IT Architect and 3 rounds of discussion among CFO, CMO, CIO, 8/8/2011 CIO, CMO, ICP Second round of cost analysis based on vendor provided information Senior Financial and More in-depth cost and benefit analysis based on 8/10/2011 CIO, CFO RFP created for vendor Senior Contract RFP to be developed and signed off by legal and contract team 8/15/2011 CIO, CFO, CEO Evaluation of Proposal from vendor Senior Contract Proposal review for comments document signed 8/29/2011 CIO, CFO, CMO, CNO, ICP Drafting of Contract with vendor Senior Contract First Draft of Contract 8/30/2011 CIO, CFO Signed Contract with vendor CIO Signed Contract 9/15/2011 CIO, CFO Completed Engineering Requirements Document (ERD) with vendor and IT Vendor and Senior IT Signed ERD by vendor and IT 9/30/2011 CIO Completed Engineering Design Document (EDD) with vendor and IT Vendor and Senior IT Signed EDD by vendor and IT 10/18/201 1 CIO Build 1 Code Drop and Solution Package Vendor Signed Solution Package From Build 1 11/10/201 1 CIO 8
Build 1 Engineering Test Summary Senior QA Signed Engineering Test Summary From Build 1 11/20/201 1 CIO Completed User Acceptance Test From Build 1 Senior QA Signed User Acceptance Test From Build 1 12/15/201 1 CIO, CMO, CNO, ICP Build 2 Code Drop and Solution Package Vendor Signed Solution Package From Build 2 1/15/2012 CIO Build 2 Engineering Test Summary Senior QA Signed Engineering Test Summary From Build 2 1/22/2012 CIO Completed User Acceptance Test From Build 2 Senior QA Signed User Acceptance Test From Build 2 1/31/2012 CIO, CMO, CNO, ICP Final Build Code Drop and Solution Package Vendor Signed Solution Package From Final Build 2/15/2012 CIO Final Build Engineering Test Summary Senior QA Signed Engineering Test Summary From Final Build 2/20/2012 CIO Completed User Acceptance Test From Final Build Completed Training Materials Senior QA Senior Training Signed User Acceptance Test From Final Build 2/25/2012 CIO, CMO, CNO, ICP Training Document 2/28/2012 CIO, CMO, CNO, ICP Project Completion Sign Off Vendor and CIO Project completion Gate review Sign off 3/14/2012 CIO, CFO 9
5 Major Milestones Milestone Responsible Target Begin Date Target End Date Requirements Gathering 6/1/2011 7/1/2011 Vendor Identification Senior IT Architect 7/1/2011 8/8/2011 Vendor Selection CIO 8/8/2011 8/29/2011 Engineering Requirements Document Agreed Upon and Signed by vendor and IT CIO 9/15/2011 9/30/2011 Design of the vendor system Vendor 9/30/2011 10/10/2011 Engineering Design document signed by vendor and IT CIO 10/10/2011 10/18/2011 Build 1 implementation Vendor 10/18/2011 11/10/2011 Build 1 QA Senior QA 11/10/2011 11/20/2011 Build 1 User Acceptance Test Senior QA 11/20/2011 12/15/2011 Build 2 implementation Vendor 12/15/2011 1/15/2012 Build 2 QA Senior QA 1/15/2012 1/22/2012 Build 2 User Acceptance Test Senior QA 1/22/2012 1/31/2012 Final Build implementation Vendor 2/1/2012 2/15/2012 Final Build QA Senior QA 2/15/2012 2/20/2012 Final User Acceptance Senior QA 2/20/2012 2/25/2012 User Training Training Center 3/01/2012 3/08/2012 Deployment Vendor 3/15/2012 1 Year Performance Monitoring 3 rd Party Auditor 3/15/2012 3/15/2013 10
6 Roles and Responsibilities Role Name Organization Responsibilities Time to the Project ICP Amanda Banks Infection Control - Infection identification, surveillance, prevention, and 12 hours per week Department control CNO Cara Fowler Nursing Care - impact and nursing workflows analysis - evaluate effect on bed placement - evaluate effect on patient flow - oversee training and implementation of system CMO Ash Goel Medical Office - Lead the infection control committee - participate in the project steering committee - encourage and facilitate medical staff participation in requirements and gap analysis process. CFO Lee Kauffman Finance - Establishing current costs of HAI and generating ROI. - Securing financing CIO John Wong Information Technology - Requirements Gathering - Selection of the necessary technology that can help with the prevention of HAI in our hospital - Vendor selection - Vendor management - Working with the vendor for the implementation of the various components of the infection control systems 8 hours per week 8 hours per week 8 hours per week 50% of time in this fiscal year will be dedicated to this project
7 References Department of Health and Human Services (HHS) (2009). Action Plan To Prevent HealthCare Associated Infections June 2009 Final. Retrieved 4 2011, from http://www.hhs.gov/ash/initiatives/hai/actionplan/hhs_hai_action_plan_final_0622200 9.pdf Ebno ther, C., Tanner, B., Schmid, F., Rocca, V., Heinzer, I., Bregenzer T. (2008, January). Impact of an Infection Control Program on the Prevalence of Nosocomial Infections at a Tertiary Care Center in Switzerland. Infection Control and Hospital Epidemiology, vol. 29, no. 1 Fraser, T., Fatica, C., Scarpelli, M., Arroliga, A., Guzman, J., Shrestha, N., Hixon, E., Rosenblatt, M., Gordon. S., Procop, G. (2010). Decrease in Staphylococcus aureus Colonization and Hospital-Acquired Infection in a Medical Intensive Care Unit after Institution of an Active Surveillance and Decolonization Program. Infect Control Hosp Epidemiol, 31(8):779-783 Humphreys, H. (2010). New technologies in the prevention and control of healthcareassociated infection. J R Coll Physicians Edinb, 40:161 4 Mears, A., White, A., Cookson, B., Devine, M., Sedgwick, J., Phillips, E., Jenkinson, H., Bardsley, M. (2008). Healthcare-associated infection in acute hospitals: which interventions are effective? The Hospital Infection Society,doi:10.1016/j.jhin.2008.12.004 Stevenson, K., Murphy, C., Samore, M., Hannah, E., Moore, J., Barbera, J., Houch, P., Gerberding, J., (2004). Assessing the status of infection control programs in small rural hospitals in the western United States. Am J Infect Control, 32:255-61. Stibich, M., (2010, November). Guidelines for Evaluating New Technologies for Infection Control. Infection Control Today, Retrieved 4 2011, from http://www.infectioncontroltoday.com/articles/2010/11/guidelines-for-evaluating-newtechnologies-for-infection-control.aspx