HEALTHCARE ASSOCIATED INFECTION PREVENTION

1
HEALTHCARE ASSOCIATED INFECTION PREVENTION
CONTROL

• PRELIMINARY REPORT
• APRIL 15, 2009
• Massachusetts Department of Public Health
• Betsy Lehman Center for Patient Safety and
  Medical Error Reduction
• Bureau of Infectious Disease Prevention, Response
  and Services

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HEALTHCARE REFORMChapter 58 of the Acts of 2006

• implement a proactive statewide infection
  prevention and control program . . . in licensed
  health care facilities following protocols of the
  Centers for Disease Control and Prevention (CDC)
  for the purposes of implementation and adherence
  to infection control practices. . .

3
PROCESS

• Expert panel
• 294 best practices
• Reportable outcome and process measures
• Use National Healthcare Safety Network (NHSN)
• Technical Advisory Group

4

Measure in National Healthcare Safety Network
(NHSN)
1 Public Data submitted to the Department of
Public Health 2 BLC Betsy Leman Center for
Patient Safety and Medical Error Reduction 3
Internal For reporting hospitals own use
only CVC-BSI central-venous catheter-associated
bloodstream infection, ICU intensive care unit,
SSI surgical site infection
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National Healthcare Safety Network (NHSN)

• Advantages
• Web-based
• Tested and validated definitions and data
  elements
• Custom fields
• Offers national comparisons
• Confidentiality guaranteed
• Help desk and training
• Free of charge
• Recognized problems
• Not designed for public reporting
• Issues with enrollment and assigning rights
• Maintenance of data and data entry time-consuming
• Data need to be validated, internal checks not
  extensive
• Fields for Massachusetts race/ethnicity had to be
  added
• Not designed for intensity of use (required in 21
  states)

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SUMMARY

• Reporting period July 1, 2008 October 31, 2008
• 8 of 74 acute care hospitals not included because
  of NHSN difficulties that have since been
  addressed
• 5 hospitals with NICUs reporting
• 42 hospitals with bed size of less than 200
• Non-teaching community, community, university
  hospitals included
• Outcomes
• Central venous catheter associated blood stream
  infections (CVC-BSI)
• 50 criterion 1 adult pediatric
• 6 criterion 1 NICU
• CVC use similar to or less than national
  utilization
• Surgical site infections (SSI)
• 7 primary knee arthroplasty
• 10 total or partial hip arthroplasty

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CVC-BSI RATES
CENTRAL VASCULAR LINE BLOODSTREAM INFECTION RATES
MASSACHUSETTS (7/1/08-10/31/08) NATIONAL NHSN
DATA (2006-2007) ADULT PEDIATRIC 1
CVC-BSI Rate number of CVC-BSI /number of line
days x 1000 1 Eight cases omitted due to problems
categorizing the ICU type
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CVC-BSI RATES NICUs
CENTRAL VASCULAR CATHETER BLOODSTREAM
INFECTIONS MASSACHUSETTS (7/1/08 10/31/08)
NATIONAL NHSN DATA (2006 2007)
CVC-BSI Rate number of CVC-BSI /number of line
days x 1000
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SSI ADULT PEDIATRIC
DEEP ORGAN SPACE SURGICAL SITE INFECITON RATES
N.B. Observation period lt4
months. Observation period for definition 1
year. 80 of infections present within 60
days. More than half had less than 60 days.
The SSI rate is calculated by dividing the number
of infections by the number of procedures
multiplied by 100.
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CAUSATIVE ORGANISMS IN ADULT AND PEDIATRIC
CVC-BSIs
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OTHER ACTIVITIES

• MRSA point prevalence
• Influenza vaccinations of employees
• Assessment visits
• Other facility types
• Extended care (ltc, ltac, rehab)
• Ambulatory surgical centers
• Dialysis centers
• Training education
• Public awareness

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NEXT STEPS

• Assure Data Quality
• onsite visits to validate data
• risk adjustment
• Expand Program to Other Facility Types
• Continue to determine outcome process measures
  for LTC, Dialysis, Ambulatory Surgery,
  long term acute hospitals
• Training Prevention
• Technical training on data entry
• Work with Coalition on prevention programs for
  professionals, patients the public
• Infection Preventionists complete assessment
  visits to assist facilities in program
  development
• Reporting
• plan for February, 2010
• Develop Process for Moving BLC Items to the
  Public Column

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Relationship to HCQCC Milestones