Using Collaboratives to Reduce Central LineAssociated Bloodstream Infections CLABSI: A National Impl

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Using Collaboratives to Reduce Central
Line-Associated Bloodstream Infections (CLABSI)
A National Implementation Program

• Peter Pronovost, MD
• John R. Combes, MD

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Overview

• Context and National Leadership
• State Level Consortia
• Sustainability
• QA

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National Contextand Leadership
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HHS Steering Committee for the Prevention of HAI

• Charge Develop an Action Plan to reduce,
  prevent, and ultimately eliminate HAIs
• Plan will
• Establish national goals for reducing HAIs
• Include short- and long-term benchmarks
• Outline opportunities for collaboration with
  external stakeholders
• Coordinate and leverage HHS resources to
  accelerate and maximize impact

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Steering Committee Working Group Structure
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HHS Action Plan

• Initial version issued in January 2009
• Public comment received in February 2009
• Revision finalized in June 2009
• HHS Action Plan Website
• http//www.hhs.gov/ophs/initiatives/hai

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Tier One Priorities

• HAI Priority Areas
• Catheter-Associated Urinary Tract Infection
• Central Line-Associated Blood Stream Infection
• Surgical Site Infection
• Ventilator-Associated Pneumonia
• MRSA
• Clostridium difficile

• Implementation Focus
• Hospitals

Tier Two will address other types of healthcare
facilities
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AHAs Hospitals in Pursuit of Excellence

• Reduce Surgical Infections and Complications
• Reduce Central Line-associated Blood Stream
  Infections (CLABSI)
• Reduce methicillin-resistant Staphylococcus
  aureus (MRSA)
• Reduce clostridium difficile infections (c diff)

• Reduce ventilator-associated pneumonia (VAP)
• Reduce catheter-associated urinary tract
  infections
• Reduce adverse drug events from high-hazard
  medications (e.g., anticoagulants, narcotics,
  opiates, insulin, sedatives)
• Reduce pressure ulcers

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State Consortia
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Project Organization

• Statewide effort coordinated by State Hospital
  Association including QIOs and State DOHs
• Collaborative model
• Standardized data collection tools and evidence
• Local ICU modification of implementing
  interventions
• Implementing interventions outside the ICU

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Participating States

• 10 states with at least 10 hospitals in 2008-2011
• California North Carolina
• Colorado Ohio
• Florida Pennsylvania
• Massachusetts Texas
• Nebraska Washington

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CUSP EXPANSION

• All hospitals within the states are eligible
• The following states are in the expansion
• Alabama, Alaska, Arizona, Delaware, District of
  Columbia, Idaho, Iowa, Kansas, Kentucky,
  Louisiana, Maine, Maryland, Mississippi, Montana,
  Nevada, North Dakota, Puerto Rico, South Dakota,
  Utah, Vermont, Virginia, Wyoming

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JHU Funded State Projects

• Healthcare Association of New York State
• Oklahoma Hospital Association
• Oregon Hospital Association
• South Carolina Hospital Association
• Tennessee Hospital Association
• West Virginia Hospital Association
• Wisconsin Hospital Association

• Arkansas Hospital Association
• Connecticut Hospital Association
• Georgia Hospital Association
• Healthcare Association of Hawaii
• Illinois Hospital Association
• Indiana Hospital Association
• Minnesota Hospital Association
• Missouri Hospital Association
• New Hampshire Hospital Association
• New Jersey Hospital Association
• New Mexico Hospital Association

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State Consortia Members

• State hospital associations
• QIOs
• State health departments
• May include
• Payers
• PSOs
• Government officials
• Business

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State Hospital Associations

• Serve as project coordinator for state consortia
  and participating hospitals
• Facilitate conference calls and in-person
  meetings with HRET/JHU/MHA faculty
• Oversee collection of CLABSI and safety culture
  data

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Role of QIOs

• Part of state infrastructurelend expertise and
  other resources to support initiative
• Participate in conference calls, in-person
  meetings

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Building State Programs to Prevent HAIs

• Project Description
• Create and expand state-based HAI prevention
  collaboratives
• Build a public health HAI workforce in states
• Enhance states abilities to assess where HAIs are
  occurring
• Agency Lead CDC
• Collaborating Agencies AHRQ and CMS
• Funds Source Amount ARRA (40 M)
• CDC HAI Recovery Act Website
• http//www.cdc.gov/nhsn/ra

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Consortia Organization

• Lead Partner Role State Hospital Association or
  affiliated state hospital association
  organization coordinating the state-wide
  collaborative.
• Advisor role will support the collaborative
  effort with infectious disease expertise.
• Endorser role will support the collaborative by
  promoting On the CUSP Stop BSI and by providing
  cash or in-kind resources such as meeting space.

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NC Safer ICUs Eliminating CLABSI Collaborative
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Florida Consortium
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Evolving Consortia Roles

• SHA
• Recruitment, Marketing, Convening
• QIO
• Training, Field Agent
• DOH
• Technical Support, Analysis, Epidemiology

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Sustainability
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State Consortia Sustainability

• State consortia key to sustainability
• Train-the-trainer education to build capacity for
  future patient safety innovations, e.g., On the
  CUSP Decubiti
• Evaluation component to identify lessons,
  including critical success factors and barriers

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FLEXTRA Kit

• A model for the development of resource materials
  to support instructor-delivered in service
  training and faculty development
• Contains
• Instructors/Leaders Guide
• Camera ready materials for handouts
• Presentation materials (PowerPoint slides
  videos)
• Evaluation instruments
• Battles JB, Sheridan MM The FLEXTRA Kit a model
  for instructor
• support materials. J Biocommunication
  1989631-13. 6

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CUSP FLEXTRA Kit

• Begins with all existing content as well as new
  content developed as part of the project
• Identifies key concepts to be illustrated through
  video vignettes
• Work with experts in CUSP, care in each selected
  hospital unit, and adult learning to develop
  storyboards and final scripts for the vignettes
• The compilation of the video vignettes supervised
  by clinical experts
• The embedding of the video content into DVD and
  CD format suitable for bundling with other
  training materials
• The development and editing of the instructional
  guides, in collaboration with experts in both
  CUSP and adult learning concepts
• The final bundling of all the resources into
  print and electronic formats that are
• Fully in the public domain
• 508 compliant
• Branded as an AHRQ product, but designed to be
  co-branded

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Emanuel,L (2009)
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Conclusion
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HAI Elimination Collaboration
Policy Leadership
AHRQ CDC CMS AHA
Field Leadership
JHU MHA HRET NW
Implementation Leadership
SHA DOH QIO
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Summary

• National Commitment
• Strong Collaboration
• Federal Agencies
• Provider Organizations
• State Stakeholders
• Local Consortia Sustainability
• Unit Based Culturally Driven Improvements

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Questions