2012 middle tn apic chapter conference 9-13-12 engaging our most valuable resource in infection...

2012 Middle TN APIC Chapter Conference 9-13-12

Engaging our Most Valuable Resource in Infection Prevention: Our Patients

J. Hudson Garrett Jr., PhD, MSN, MPH, FNP, CSRN, VA-BC, DON-CLTC, C-NAC

Senior Director, Clinical AffairsPDI Healthcare


Financial Disclosures

PDI Healthcare-Employee

2012 Conference Planning CommitteeAssociation for the Healthcare Environment

Recommended Practices Advisory BoardAssociation for Perioperative Registered Nurses

Vice President, Board of DirectorsVascular Access Certification Corporation

President, Board of DirectorsSE Chapter of the Infusion Nurses Society

Board of Directors, Education ChairpersonGreater Atlanta Chapter Association for Professionals In Infection Control and Epidemiology


Program Objectives

• Discuss the role of the patient and family in the prevention of Healthcare Associated Infection

• Discuss strategies to include patient accountability for Joint Commission NPSG 7

• Review patient and family involvement and empowerment strategies to reduce the incidence of HAIs


Healthcare-Associated Infections (HAIs) 1 out of 20 hospitalized patients

affected Associated with increased mortality Attributed costs: $26-33 billion

annually HAIs occur in all types of facilities,

including: Long-term care facilities Dialysis facilities Ambulatory surgical centers Hospitals


HHS Action Plan 5-year GoalsMetric National 5-year

Prevention Target Source

Central line-associated bloodstream infections 50% reduction NHSN

Adherence to central-line insertion practices 100% adherence NHSN

Clostridium difficile infections and hospitalizations 30% reduction NHSN, NHDS, HCUP

Catheter-associated urinary tract infections

25% reduction NHSN

MRSA invasive infections (population) 50% reduction EIP

Surgical site infections 25% reduction NHSN

Surgical Care Improvement Project measures 95% adherence SCIP

NHSN – CDC’s National Healthcare Safety Network EIP – CDC’s Emerging Infections ProgramNHDS – CDC’s National Hospital Discharge Survey SCIP – CMS’s Surgical Care Improvement ProjectHCUP – AHRQ’s Healthcare Cost and Utilization Project


Fundamental Question

What role, responsibilities, and rights does

the patient have in the HAI Prevention

Process?


Could this be You Family Member?


What do these have in common?

http://www.tsa.gov/index.shtm

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Transmission of Infection


How Does Transmission Occur?

Patient

Healthcare Worker

Environmental Surfaces

Patient Care Equipment


How do you view mortality?


The Story Begins


Hand Hygiene Technique


Hand Hygiene

• Significant numbers of HAIs could be prevented if we practiced HH when indicated


Adherence to infection control guidelines is incomplete Many HAIs are preventable with current

recommendations Failure to use proven interventions is unacceptable Only 30%-38% of U.S. hospitals are in full

compliance Just 40% of healthcare personnel adhere to hand

hygiene Insufficient infection control infrastructure in non-

acute care settings has allowed major lapses in safe care


Where do you even begin?

http://www.jointcommission.org/

http://www.ins1.org/


The Story Continues


External Pressures

Payment Reform

Decreased reimbursement

Staffing Challenges

Public Reporting

Accountable Care Organizations

NHSN


Patient Education-Long Lost Art

• Patient Print-Outs at Time of Discharge• What about an interactive approach to patient

and family education– Signs and Symptoms of Infection– Actions to Take if Suspected– How to communicate concerns with your

healthcare provider– Activating RRT


Family Support

Psychologically beneficial in recovery

Primary Caregivers

Home Health Support

Patient Advocacy

Primary Caregiver Responsibility

Best Line of Defense


Patient’s versus Nurse’s responses to...


NPSG 7

• Hand Hygiene• MDROs

– MRSA– CDI– VRE– MDR Gram Neg

• CLASBI• SSI• CAUTI


Speak Up Campaign


Antimicrobial Stewardship


Ten Steps for Safer Care-Part I

Speak up Keep hands clean

Ask if you still need a central line catheter or urinary catheter

Ask your healthcare provider, "will there be a new needle, new syringe,

and a new vial for this procedure or injection?"

Be careful with medications


Ten Steps for Safer Care-Part II

Get Smart about

antibiotics.

There are things you can do to reduce your

risk of getting a surgical site infection.

Watch out for C. diff

Know the signs and symptoms

of infection

Get your flu shot


CDC knowledge and data fuels local to national CLABSI prevention

UnitFacilityPittsburgh Regional

Healthcare Initiative

First successful, large-scale

CLABSI prevention

demonstration project

Regional

Subsequent projects

based upon CDC

prevention:• Michigan

Keystone

• Institute for Healthcare Improvement

• Others

NationalNational

expansion of CLABSI

prevention 60% Reduction in CLABSI between

1999-2009 • State-based

public reporting using NHSN

• State/regional prevention collaboratives (CUSP, Recovery Act projects)

• CMS/IPPS – hospitals report CLABSIs for full Medicare payment

Inputs

Outputs

Outbreak Investigations

Prevention Research

(e.g. chlorhexidin

e bathing)

NHSN Data

CDC Guidelines


The need for HAI prevention researchH

ealth

care

-ass

ocia

ted

Infe

ction

Preventable

Prevention Approach Unknown

Prevented

Need for complete implementation of practices known to prevent HAIs

Need for ongoing research to identify new strategies to prevent the remaining HAIs


Summary

• Patients and families are the last line of defense

• HCP should fully engage all of the care team and family to serve as advocates

• When it doesn’t seem right-it most likely isn’t• Infection Preventionists are SMEs, but unit-

based expertise is needed


Payors

MedicalProfessionals

Consumers

Public Health

Patients

GovernmentHealthcareFacilities

Safe Healthcare is Everyone’s Responsibility


Hypothetical ? • If you knew……………………….

• That you could do something simple, easy, cost effective, and that was

• Evidence-Based, but took a little extra time…..

• Would you do it????? What if it was your loved one?


References

• US Centers for Disease Control and Prevention, www.cdc.gov/hai

• National Patient Safety Goals, The Joint Commission,, 2012.

• Speak Up Campaign, The Joint Commission, 2012.

• HAI Action Plan, US Department of Health and Human Services, 2012.

http://www.cdc.gov/hai


Questions

• Whose Infection will you prevent when you return to your institution?

• Contact Information:– Email: [email protected] – Phone: 800-444-6725, ext. 8576

mailto:[email protected]

2012 middle tn apic chapter conference 9-13-12 engaging our most valuable resource in infection...

Documents

board of directorsse

transmission of infection

patient care equipment

transmission of pathogens

sources of transmission

review patient

patient accountability

infection prevention