Report To: Arizona Infection Prevention Advisory Committee Presented by: Patty Gray, RN, CIC 5202009

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Report To Arizona Infection Prevention
Advisory Committee Presented by Patty Gray,
RN, CIC 5/20/2009DHSS HAI
Action Plan Prioritized Recommendations
U.S. Department of Health and Human Services
Action Plan to Prevent Healthcare-Associated
Infection Draft for Public Comment January 06,
2009
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HAI Action Plan Prioritized Recommendations

• Goal of this Segment of the Action Plan
• Prioritize the CDC Recommendations for
  Prevention of HAIs
• 1200 such recommendations currently
• Limited guidance on implementation or
  prioritization THEREFORE
• Steering Committee HICPAC evaluated and
  prioritized four (4) key CDC Guidelines
• CAUTI, SSIs, VAPs, BSIs (account for 80 of all
  HAIs)

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Method for Prioritization

• Pool of recommendations narrowed to only those
  with strong evidentiary support (Categories 1A
  1B) those with State and Federal regulations
  (Category 1C)
• VAP prioritization includes SHEA Compendium
  recommendations in order to capture practices not
  included in CDC 2003 Guideline
• Recommendations grouped based on interdependence
  in implementationreferred to as Priority Modules
• Most recommendations correlate with SHEA/IDSA
  Compendium of Strategies to Prevent HAIs

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Prevention of Catheter Related UTIs (CAUTI)

• Current CDC Guideline from 1981 being updated due
  in 2009, therefore will provide the greatest
  implementation and auditing detail (newest)
• Three Priority Modules (7 total Recommendations)
• Recommendations for Appropriate Urinary Catheter
  Use
• Recommendations for Aseptic Insertion
• Recommendations for Proper Urinary Catheter
  Maintenance

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Example of CAUTI Priority Module 1
Recommendations for Appropriate Urinary Catheter
Use

• HICPAC Rec Insert catheters only for appropriate
  indications, and leave in place only as long as
  needed (Category 1A)
• HICPAC Rec Do not use urinary catheters in
  patients and nursing home residents for
  management of incontinence (Category 1 B)
• HICPAC Rec For Operative patients, who have an
  indication for an indwelling catheter remove the
  catheter as soon as possible post-operatively,
  preferably within 24 hours (Category 1 B)
• 4 other Recommendations rest in Priority Modules
  2 and 3 for this category..

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Prevention of Intravascular Catheter-Associated
Infections

• Priority Module 1
• Recommendations for Aseptic Insertion of
  Vascular Catheters (7 recommendations)
• Priority Module 2
• Recommendations for Appropriate Maintenance
  of Vascular Catheters ( 3 Recommendations)

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Prevention of Surgical Site Infections

• Priority Module 1
• Recommendations for Appropriate Pre-Operative
  Measures
• (8 recommendations)
• Priority Module 2
• Recommendations for Appropriate
  Intra-operative Measures
• ( 2 recommendations)
• Priority Module 3
• Recommendations for Appropriate
  Post-Operative Measures
• ( 1 recommendation)

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Prevention of VAPs

• Priority Module 1
• Recommendations for Routine Care of Patients
  Requiring Mechanical Ventilation
• (6 SHEA Compendium Strategies)
• Priority Module 2
• Recommendations for Appropriate Cleaning,
  Disinfection Sterilization of Ventilator
  Equipment
• (5 recommendations)
• Priority Module 3
• Recommendations for Appropriate Maintenance
  of Ventilator Circuit and Associated Devices
• (3 recommendations)