Title: Healthcare Associated Infection Prevention and Control Program: Update on DPH Campaign December 4, 2
1Healthcare Associated Infection Prevention and
Control ProgramUpdate on DPH Campaign December
4, 2007
- Massachusetts Department of Public Health
- Betsy Lehman Center for Patient Safety and
Medical Error Reduction - JSI Research and Training Institute, Inc.
2Problem
- Healthcare-associated infection (HAI) has been
increasingly identified as a cause of preventable
illness and death. -
- In the United States, HAIs adversely affect
approximately 2 million hospitalized patients and
result in 90,000 deaths each year. - The occurrence of and accountability associated
with HAI has become a priority issue for
patients, consumer groups, patient safety
organizations, regulatory agencies, professional
practice advisory committees and state and
federal policy makers.
3Legislation
4Impact in Massachusetts
- Using various sources, annual HAI costs in MA are
approx. 200 million - 88 of costs come from three infections
- Surgical Site Infections - 87 million
- Blood Stream Infections - 72 million
- Pneumonia - 40 million
-
5 In response Lehman Center Report on Healthcare
Associated InfectionsIdentified Needs
6I. Develop Optimal Infection Control Programs
- Reviewed and provided feedback on available
literature and standards -
- Surveyed hospitals regarding current practices
-
- Formulated recommendations based on available
information on critical components and key
activities of an Infection Control program
7Findings from Survey of Infection Control Staff
at State Hospitals
- Vast majority feel management is supportive
- Split on whether resources are adequate
- 60 do not feel management has a good
understanding of the Infection Control Programs
key tasks and responsibilities - 96 would like more support or different type of
support (including more staff and IT resources)
8II. Offer Concrete Best Practice
Recommendations
9Best Practice Guidelines
- Adapted from nationally accepted standards of
care (CDC, HICPAC, APIC, SHEA and the American
Thoracic Society). - Guidelines will provide Massachusetts hospitals
with a comprehensive list of updated
recommendations to promote improvement.
10Example of Best Practice Guidelines Ventilator
Associated Pneumonia
- Elevate HOB 30-45. A-I
- Document degree of elevation using validated
instruments or bed markings every 8 hours. A-I - Daily interruption or lightening of sedation.
A-II - Orotracheal intubation and orogastric tubes
preferred over nasotracheal intubation and
nasogastric tubes. - B-II
- 5. Endotracheal tube should be of proper size
and cuff pressure should be maintained at the
minimal occluding volume to prevent leakage of
bacterial pathogens around the cuff into the
lower respiratory tract without inducing tracheal
injury. B-II
11 III. Provide Direction on Public Reporting and
Communication
- Reviewed available literature, recommendations
and reports on public and across-hospital
reporting of individual HAIs - Reviewed current approaches to communication and
education of public on HAI, including
consideration of risk adjustment - Formulated recommendations for MDPH and Lehman
Center on public reporting and communication
12In Response to the ReportDPH Program Goals
- Implement prevention oriented educational,
training and technical assistance efforts at
hospitals - Require hospitals to report on HAIs as well as on
Prevention and Control activities - Prepare consumers/patients to be well-informed
and active participants in the elimination of
HAIs
13Goal 1 Implement Prevention-Oriented
Educational Programs and Consultative Support for
Hospitals
- Engagement of hospital leadership designate an
improvement team, review results, and share
strategies - Improvement Advisory Group advise on curriculum
and improvement strategies - Learning Sessions hospital teams hear from
experts, share materials and report lessons
learned
14Goal 1 Implement Prevention-Oriented Educational
Programs and Consultative Support for Hospitals
- Resources
- Develop toolkits based on local and national
programs - Revise toolkit through testing by the improvement
teams - Share toolkits at educational programs, on
listserve, and on website
15Goal 1 Implement Prevention-Oriented Educational
Programs and Consultative Support for Hospitals
- 5. Other Support Services
- Review and discuss monthly hospital reports
- Regular conference calls with national models and
MA hospital teams - Statewide listserve for consultation among
improvement teams - On-site visits
- 6. Strategies for patients families materials
for hospitals to provide to patients and families
to be active partners in care, and sharing
successful strategies
16Goal 2 Mandatory Reporting
- Regulations will require hospitals to report
selected outcome and process measures to the
National Healthcare Safety Network (NHSN). - Reporting hospitals will provide three levels of
access to the data - DPH will have access to data that it will prepare
for public reporting - The Betsy Lehman Center will have access to data
that are not quite ready for public reporting - Individual hospitals will see their own data and
aggregate data from other hospitals
17Reporting Recommendations
- Level 1 Reporting to the public
- Outcome measures
- Bloodstream infections assoc. with central venous
catheters in ICU patients (pathogens) A-IV - Surgical site infections from total hip and knee
replacements B-IV - Process measures
- Influenza vaccination of healthcare workers
- (pending final Task Group approval)
18General Public--- Themes
- HAIs are a frightening concept interest limited
to immediate and direct personal relevance - HAI rates rank lower in importance than
experiences (family, friends, personal) for
selecting a hospital - In reports,
- using summary safety scores may be most effective
- numbers are preferred over summary symbols (i.e.,
consumer reports approach) - simple graphs are useful
- risk adjustment and statistical aspects are
confusing - keep things brief
19Reporting Recommendations
- Level 2 Reporting to oversight agency
- Outcome measures
- Bloodstream infections assoc. with central venous
catheters in all ICU patients (common skin
contaminants) B-II - Surgical site infections from CABG and total
vaginal and abdominal hysterectomies B-IV - Process measures
- VAP prevention --- head of bed elevation and
daily assessment of readiness to wean B-II - MRSA point prevalence
- (pending final Task Group approval)
20Reporting Recommendations
- Level 3 Reporting within hospital only
-
- Outcome measures
- Bloodstream infections assoc. with central venous
catheters outside of ICUs (pathogens and common
skin contaminants) B-IV - Rates of ventilator-associated pneumonia A-II
21Goal 2 Oversight
- Inspection of hospitals on a regular basis by
Department of Public Health surveyors - - rates of infections
- - best practices
- - policies and procedures
- Compliance with State Licensing and Federal
Medicare and Medicaid regulations - Protocols specific to infection prevention and
control
22Goal 3 Consumer Education Activities
- Task Group on Reporting Communication with
previous assessment of available materials and
needs - Ongoing formative research and testing of
approaches to conveying HAI outcome data to
public - Hospital survey data from ICPs on current
practices and tools for educating
patients/families - Guidance from Expert Panel on needs and gaps
- Current discussions about best approaches,
involving outside groups focused on patient
education and empowerment
23Collaborate with many other partners on this
critical issue
- Health Care Quality and Cost Council
- Massachusetts State Legislature
- Massachusetts Hospital Association
- Coalition for the Prevention of Medical Errors
- JSI Training and Research
- Massachusetts Medical Society
- Health Care for All
- Betsy Lehman Center