Healthcare Associated Infection Prevention and Control Program: Update on DPH Campaign December 4, 2 - PowerPoint PPT Presentation

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Healthcare Associated Infection Prevention and Control Program: Update on DPH Campaign December 4, 2

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Title: Healthcare Associated Infection Prevention and Control Program: Update on DPH Campaign December 4, 2


1
Healthcare 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.

2
Problem
  • 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.

3
Legislation
4
Impact 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
  • Released August, 2007

6
I. 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

7
Findings 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)

8
II. Offer Concrete Best Practice
Recommendations
9
Best 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.

10
Example 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

12
In 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

13
Goal 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

14
Goal 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

15
Goal 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

16
Goal 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

17
Reporting 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)

18
General 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

19
Reporting 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)

20
Reporting 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

21
Goal 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

22
Goal 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

23
Collaborate 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
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