bugging out: strategies for reducing bacterial load and...
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Bugging Out: Strategies for Reducing Bacterial Load and Healthcare Acquired
Infections in your Unit
Kathleen M. Vollman MSN, RN, CCNS, FCCM, FCNS FAANClinical Nurse Specialist / Educator / Consultant
ADVANCING NURSINGkvollman@comcast.net
Northville Michiganwww.vollman.com
© ADVANCING NURSING LLC 2019
Disclosures for Kathleen Vollman
• Consultant-Michigan Hospital Association Keystone Center
• Subject matter expert for CAUTI and CLABSI, HAPI, C-Diff and Sepsis for CMS/HIIN
• Consultant and speaker bureau:– Sage Products LLC
• Will be addressing an off label use of a 2% CHG pre-op prep cloth
– Eloquest Healthcare– Urology division of Medline
Industries
Session Objectives
• Identify modes of transmission for the spread of microorganism in the healthcare environment
• Evaluate key evidence based care practices that can reduce bacterial load and/or prevent health care acquired infections.
• Discuss key program steps for creating a source control program within your practice environment or organization.
Notes on Hospitals: 1859
“It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm.”
Florence Nightingale
Advocacy = Safety
Harm in U.S HealthCare• Analysis of Scientific
Literature– Adverse events 3rd
leading cause of death– 1 in every 3 hospitalized
patient experiences preventable harm
– Est 400,000 individuals die from those injuries per year
Makary MA, et al. BMJ, 2016;353
Magill SS et al. NEJM 2014;370:1198-208Magill SS, et al. NEJM 2018;379:1732-1744
HAI 2011- 11,282 patients
2015 – 12,299 patients
Pneumonia .98% .89%CDI .54% .54%SSI .97% .56%BSI .44% .41%UTI .58% .32%GI other .22% .25%
Patients at risk for an HAI is 16% lower in 2015 versus 2011
Comparison of HAI’s between 2011 and 2015 in Acute care
Cost of MDRO’s
• 23,000 deaths associated with MDRO’s• Between $1700 to $4600 per stay• 2.39 billion in treatment costs• Staff bacteremia's 2017
– 119,000 blood stream infections– 20,000s death
• Rate of improvement has slowed nationally• VA’s have had 55% reduction in MRSA
Morbidity and Mortality Weekly Report (MMWR), March 2019Johnston KJ, et al Health Services Research, 2019 Mar 12. doi: 10.1111/1475-6773.13135
Common Routes of Transmission
HAI in the ICU was the patients’ endogenous flora (40%-60%); cross-infection via the hands of health care personnel (HCP; 20%-40%); antibiotic-driven changes in flora (20%-25%); and other(including contamination of the environment; 20%). Weinstein RA.. Am J Med 1991;91(Suppl):179S-184S.
Vertical vs. Horizontal
• Horizontal approach to infection prevention and control measures refers to broad-based approaches attempting reduction of all infections due to all pathogens– no screening– Universal nasal coverage– CHG bathing– No isolation– Limit lines/tubes– Hand hygiene
• Vertical approach refers to a narrow-based program focusing on a single pathogen (selective of the specific MDRO)– AST to identify carriers– Implementation of measures
aimed at preventing transmission from carriers to other patients
• Isolation• Hand hygiene
Wenzel RP and Edmond MB.. International Journal of Infectious Diseases 14S4 (2010) S3–S5
Reducing MDRO’s
Calfee DP, et al. Infect Control Hosp Epidemiol, 2014;35(7):772-796Huang SS, et al. New Engl J of Med, 2013;368(24):2255-65Health Research & Educational Trust (2017). MDRO Change Packect. Accessed at www.hret-hiin.org.
Hand Hygiene
Practice Device Bundles
Patient Decolonization
Decontamination of Environment
Antibiotic Stewardship
Contact Precautions/
Isolation
Hand Hygiene is the Single Most Important Factor in Preventing the
Spread of Infection
Healthcare providers clean their hands less than half of the times they should!!
Guidelines for Hand Hygiene in Health Care Settings• Alcohol-based hand rub frontline method for decontaminating
hands (20-30 seconds) • Visibly soiled or exposure to potential spore forming organisms,
wash with a non-antimicrobial or antimicrobial soap & water (40-60 seconds)
• Do not use Triclosan containing soaps• Decontaminate hands after removing gloves• Provide HCW with hand lotions & creams to minimize occurrence
of irritant contact dermatitis • Use multidimensional strategies to improve hand hygiene practice
(IA)• Do not wear artificial fingernails or extenders
CDC. Hand Hygiene Guidelines: MMWR 2002; 51(No. RR-16):[1-45]WHO Hand Hygiene Guidelines 2009Ellingson K, et al. Infect control & Hosp Epidemiology, 2014;35(2): S155-S178https://www.cdc.gov/handhygiene/science/index.html
Correct use can reduce colony forming units by 90%, incorrect use only 60%. 1-3mL correct amount per HH episodeLausten S, et al. Infect Control Hosp Epidemio, 2008;29:954-956
When to Wash
Pittet D. Infect Control Hosp Epidemiol, 2009;30(7):611-622WHO Hand Hygiene Guidelines 2009Ellingson K, et al. Infect control & Hosp Epidemiology, 2014;35(2): S155-S178
Wash In
Wash Out
Similar rates of HH complianceSunkesula VCK, et al AJIC, 2015;43:16019
Hand Hygiene Measurement Methods
• Direct Observation• Product Usage/Volume• Automation monitoring can
improve compliance• Electronic versus direct
observation more accurate in measuring compliance
Morgan DJ, et al. AJIC, 2012;40:955-959
Haas and Larson Journal of Hospital Infection 2007;66:6-14Polgreen PM, et al. Infect Control & Hosp Epidemiol, 2010;31:1294-1297Ellingson K, et al. Infect Control & Hosp Epidemiol, 2014;35(S2):S155-178
Increase use of alcohol hand rub (measure by volume use) correlated significantly (p=0.014) with improvement in MRSA rates Sroka S, et al. J of Hosp Infect, 2010;74:704-211
Hand Hygiene: Should We use Automated Systems
• Pro: Prolific amount of data; provider specific data
• Con: Lose real time correction; can be bulky and expensive
Without a process to address low compliance in a professional accountable manner it will just be a lot of data –Dr Talbot
HIIN 2018; Discovery and Direction Series: Horizontal Practices accessed at http://www.hret-hiin.org/resources/display/discovery-and-direction-series-horizontal-practices
The Environment
Substantial scientific evidence has accumulated that contamination of environmental surfaces in hospital rooms plays an important role in the transmission of several key health care–associated pathogens
Weber DJ, AMIC, 2016;44:77-84
Application of Recommendations for Environmental Cleaning
• Resources to ensure effective cleaning and decontamination• Use of a check list• Clean equipment that is transported from room to room• Dedicated equipment in isolation rooms• Reduce load-adequate time to clean• Education of healthcare workers and support staff
• Daily disinfection of non-critical surfaces vs. just visibly soiled• Feedback method using removal of intentional applied marks
visible only under UV light• Wipes that keep the surface wet for 1-2 minutes• Reusable cloths change with each room clean and use 3 per
room
Huang SS, et al. Arch Intern Med 2006;166(18):1945-1951Weber DJ, AJIC, 2016;44:77-84
Improving Environmental Hygiene In 27 ICUs Decreased MDRO Transmission
• 27 acute care hospitals ( 25 beds to 709 beds)
• Fluorescent targeting method • Systematic covert monitoring was performedResults:• 3532 environmental surfaces were assessed
after terminal cleaning in 260 ICU unit rooms• 49.5% of services cleaned it baseline• Post-intervention with multiple cycles of
objective performance feedback resulted in 82% of environmental services cleaned (p < .0001)
Carling PC, et al. Crit Care Med, 2010;38:1054-1059
No Touch Cleaning• Use of a no touch method leads to a decreased rate of infection in
patients subsequently admitted to a room where the prior occupant was colonized or infected.
• Use of a no touch method leads to a decreased rate of facility-wide colonization and infection.
• Hydrogen peroxide vapor & aerosolized significantly reduce MDRO load in terminal cleaning. (vapor:1.5 to 2.5hrs, aerosolized: 2-3hrs)– Aerosolized not well studied versus vapor– Contaminated surfaces reduced to 0% to <5%
• Ultraviolet–C to kill pathogens.– 10-45 minutes of use, C. difficile spores – 10-25 minutes for non-spore forming bacteria– Contaminated surfaces reduced <1% to <11%
Nerandzic MM, et al. BMC Infect Dis 2010 Jul 8;10:197Havill NL et al. Infect Control Hosp Epidemiol, 2012;33:507-512Sattar SA, et al. AJIC, 2013;S97-104Passaretti Cl, et al. Clin Infect Dis,2013;56:37-35Weber DJ, AJIC, 2016;44:77-84
Reducing the Load in the Environment: Additional Factors• Hospital curtains potential source of transmission1
– Novel curtains increase time to first contamination (7x longer)2
• Daily cleaning of high touch surfaces3
• Disinfecting surfaces (copper/silver coating)4
• ECG disposable or reusable?5
– Cluster-randomized controlled design– Match ICU’s randomized to get disposable
or reusable ECG– Measured infection rates
1.Trillis F, et al. Infect Control Hosp Epidemiol, 2008;29(11):1074-10762.Schweizer M et al. Infect Control Hosp Epidemiol 2012;33:1081-10853.Kundrapu S, et al. Infect Control Hosp Epidemiol 2012;33(10):1039-424. Salgado CD, et al. Infect Control Hosp Epidemiol 2013;34:479-865.Ablert NM, et al. Amer J of Critical Care, 2014;23:460-468
Reducing Bacterial Load on the Patient:
A Horizontal Strategy
Evidence Based Bathing Practices
Patient Decolonization
nurWse!
Traditional BathingWhy are there so many bugs
in here?
Soap and water basin bath was an independent predictor for the development of a CLABSI
Bleasdale SC, e tal. Arch Intern Med. 2007;167(19):2073-2079
Bath BasinsPotential Source of InfectionLarge multi-center study evaluates presence of multi-drug resistant organisms
Marchaim D, et al. Am J of Infect Control. 2012;40(6):562-564
3%35%
MRSA36 basins/28 hospitals
62%
Contaminated686 basins/88 Hospital
Colonized w/ VRE385 basins/80 hospitals
45%
Gram negative bacilli495 basins/86 hospitals
Total hospitals: 88Total basins: 1103
Used with Permission Advancing Nursing LLC Copyright 2013 AACN and Advancing Nursing LLC
Mechanisms of Contamination
• Skin flora• Multiple-use basins
–Incontinence cleansing–Emesis–Product storage
• Bacterial biofilm from tap water
Shannon RJ, et al. J Health Care Safety Compliance Infect Control. 1999;3:180-184.Larson EL, et al. J Clin Microbiol. 1986;23(3):604-608.Johnson D, et al. Am J Crit Care, 2009;18(1):31-38, 41.Marchaim D, et al. Am J Infect Control. 2012;40(6):562-564.
Used with Permission Advancing Nursing LLC Copyright © 2013 AACN and Advancing Nursing LLC
Waterborne Infection
Hospital Tap Water Bacterial biofilm Most overlooked source for pathogens 29 studies demonstrate an association with
HAIs and outbreaks Transmission:
-Drinking-Bathing-Rinsing items-Contaminated environmental surfaces
Immunocompromised patients at greatest risk
Anaissie EJ, et al. Arch Intern Med. 2002;162(13):1483-1492.Cervia JS, et al. Arch Intern Med, 2007;167:92-93Trautmann M, et al. Am J of Infect Control, 2005;33(5):S41-S49,
Used with Permission Advancing Nursing LLC Copyright © 2013 AACN and Advancing Nursing LLC
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QTR 1FY05
QTR 2FY05
QTR 3FY05
QTR 4FY05
QTR 1FY06
QTR 2FY06
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Impact on UTI with Basin Bathing
UTI Rate- Removal of Prepackaged Bath Product QTR 3 FY05
McGuckin M, et al. AJIC, 2008;36:59-62,
The Effect of Bathing with Basin and Water and UTI Rate, LOS and Costs
Unit Census: 14Phases Product Cost/ No. of
UTIMedian4
LOS17 Days
Median4
Cost(4857.00)
I- Pre-Packaged Bathing Washcloths(9 months)
$10,5301
($3.00)25 175 $117,175
II- Basin/Water(9 months)
$3,5102
($1.00)48 336 $224,916
III- Additional Product Cost, UTI, LOS, COSTS
$7,020 233 151 $107,741
1Based on 3 packages of 8 towels each 2Based on product cost of towels, soap, and basin3 Difference between phase I pre-package/phase II basin water4
McGuckin M, et al. AJIC, 2008;36:59-62
*2% CHG cloth for bathing is consider an off label use of the product
*
The Evidence: Impact of 2% CHG Cloth Baths*Evaluate effect of daily bathing with CHG on acquisition of MDRO’s and incidence of CLABSI
9ICU’s & Bone Marrow Transplant unitRandomly assigned 7727 patient:a.No-rinse, 2% CHG
impregnated washcloths*
b.Non-antimicrobial, no-rinse bath cloths
Climo, M et al, N Engl J Med, 2013;368:533-542
Results of 2% CHG bathing
23% reduction 28%
reduction
50% reduction
90%reduction
*2% CHG cloth for bathing is consider an off label use of the product
Impact of 2% CHG Cloth Baths*Study to determine the best method for reducing spread of MRSA & MDROs
3 protocols tested:a)Swab for MRSA on admission to ICU
- Isolate if positiveb)Swab for MRSA on admission to ICU
- Isolate if positive- Nasal mucopiricin x 5 days- 2% CHG cloth* bathing for entire
ICU stayc)No swab
- Nasal mucopiricin x 5 days- 2% CHG bath* for entire ICU stay
Huang SS, et al. New Engl J of Med, 2013;368(24):2255-65.
Results: No Swab GroupUniversal Decolonization Demonstrated
37% reduction 44%
reduction
*2% CHG cloth for bathing is consider an off label use of the product
99 decolonization to prevent 1CLABSI
Noto MJ, et al. JAMA 2015;313:369+
Difference Between Climo & Noto Study
Dr Talbot: http://www.hret-hiin.org/resources/display/discovery-and-direction-series-special-approaches-and-essential-questions
Rhee Y, et al. Infect Control Hosp Epidemiol 2018;39:405–411
Differential Effects of Chlorhexidine Skin Cleansing Methods
• Prospective, randomized 2-center study with blinded assessment.
• To determine whether 3 different CHG skin cleansing methods yield similar residual CHG concentrations and bacterial densities on skin.
Method A- 2% CHG clothMethod B- 4% CHG liquid poured onto non-
medicated clothMethod C-4% CHG liquid on cotton wash cloth
CHG Bathing Process
Shan HN, et al. Crit Care Nurs Q, 2016;39:42-50*2% CHG cloth for bathing is consider an off label use of the product.
Monitor for compliance by assessing amount of CHG on the skin (Assay). Prevent sub-optimal concentrationsDonskey CJ, et al. American Journal of Infection Control 44 (2016) e17-e21
Cleansing of Patients with Indwelling Catheter
• Indwelling catheter care should occur with the daily bath (basinless bathing)*, as a separate procedure using clean technique
• There is no evidence to support 2x a day indwelling catheter care
• If a large liquid stool occurs, bathe the patient with basin less bathing
• Use separate cloths to clean front to back in the perineal area and 6 inches of the catheter**
• Apply barrier cloth to area of skin requiring protection
**Universal ICU Decolonization: An Enhanced Protocol. (Prepared by The REDUCE MRSA Trial Working Group, under contract HHSA290201000008i). AHRQ Publication No. 13-0052-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2013.
For Successful Banning of Basins for Patient Care
• We need to provide alternatives for the other functions:Current NewEmesis Emebags being installed in every
adult and ped pt. room, ACU, PACUStorage of patient items Clear plastic “baggies”
Trial of “Concierge List” to decrease waste of unused/unneeded products
Foot soaks Shampoo caps, prepackagedShampoo patient’s hair Shampoo caps par’d on all units24 hour urine, ice Store some basins in lab to be
dispensed with each 24 hour jug.Bath cloths with no insulation, cold halfway through bath.
Bath cloths with insulation to stay warm longer
Quinn B, et al. Presented at NACNS National Conference, March5-7th, 2015, San Diego Ca
Reducing MDRO’s
• Contact precautions for MRSA colonized & MRSA infected patients and VRE– Slower time from ER to inpatient bed
(1 hr)– Slower to discharge to extended care
facility (1.7 days)– Delays in diagnostic imaging– Visited by healthcare workers 20-
30% less– Greater patient dissatisfaction.
Calfee DP, et al. Infect Control Hosp Epidemiol, 2014;35(7):772-796Huang SS, et al. New Engl J of Med, 2013;368(24):2255-65Health Research & Educational Trust (2017). MDRO Change Packect. Accessed at www.hret-hiin.org.Morgan JD, et al. JAMA 2017;318(4):329-330
No high quality data support or reject use of CP for endemic MRSA or VRE. Our survey found more than 90% of responding hospitals currently use CP for MRSA and VRE, but approximately 60% are interested in using CP in a different manner. More than 30 US hospitals do not use CP for control of endemic MRSA or VRE.
Morgan DJ, et al. Infect. Control Hosp. Epidemiol. 2015;36(10):1163–1172
Impact of D/C Contact Precautions for MRSA & VRE
Bearman G, et al. Infect Control Hosp Epidemiol 2018;39:676–682
• Quasi-experimental (2011-2016), Interrupted time series, CP changes April 2013
• Outcomes: MRSA & VRE HAI rates
PPE Compliance: Is There a Better Way to Measure this Bedside Direct Observation?
• In short, probably not• Need to identify not only if used but
used correctly• Need to track compliance, feedback
to end-users/leadership• Any other types of audits or a better
way?????
HIIN 2018; Discovery and Direction Series: Horizontal Practices accessed at http://www.hret-hiin.org/resources/display/discovery-and-direction-series-horizontal-practices
Contact Precautions/
Isolation
Improve Accuracy of Doffing Process• Novel gown to increase
compliance with effective of gown renewal
• Outcomes– Reduce waste,– Improve cleanliness of the
environment– Prevent contamination of staff
and environment
Personal communication Sharon Dickinson
Evidence- Based Strategies for
Reducing the Risk of CAUTIs
Practice Device Bundles
1
32
Ensure Aseptic Placement
Maintain Awareness and Proper Care of Catheters in Place
Prompt Removal of Unnecessary Catheters
Step 0: AVOID
INDWELLING
CATHETERIndwelling
Urinary Catheter
Reminders/stop orders use appropriateness criteria to prompt catheter removal
Place/keep urinary catheter only when appropriate
Daily review of continued need for urinary catheter
Optimize use of alternatives
Using Appropriateness CriteriaTo Reduce Catheter Use1,2
UC Indications ׀ 50AHRQ Safety Program for ICUs: Preventing CLABSI and CAUTI
Nurse Driven Intermittent Catheterization Program
• If no voiding within 4-6 hours of assessment pre-insertion or post removal, a bladder scan ultrasound used.
• Volume < 500mL, encourage the patient to void by using techniques to stimulate bladder reflex (cold water to abdomen, stroke inner thigh, run water, flush toilet).
• Continue to assess the patient and repeat the bladder scan in 2 hours if no voiding.
• If the bladder volume > 500mL, and intake is less than 3L a day-catheterize for residual urine volume rather than place an indwelling catheter.
• If volumes are greater/catheter goes back in 24hrs
If retention is suspected:
STOP CAUTI Sample Policy and Procedure http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/hcpr/cauti/documents/Sample%20Policy%20and%20Procedures.pdfUniversity of Virginia Health System nurse driven intermittent cath program
Before Placing an Indwelling Catheter, Please Consider if These Alternatives Would be Appropriate:
• Bedside commode, urinal, or continence garments: to manage incontinence.
• Bladder scanner: to assess and confirm urinary retention, prior to placing catheter to release urine.
• Straight catheter: for one-time, intermittent, or chronic voiding needs.
• External catheter: appropriate for cooperative men without urinary retention or obstruction.
Male and Female External Collection Devices
Challenges with Current Appropriate Alternatives: External Male Catheters
1 out of every 200 men is born with what’s medically known as ‘micro-penis
Buried Penis
Innovated Male External Catheter Study
• This project was conducted in a 107-bed long-term acute care hospital
• Timeline: The QI initiative started on 02/21/16
• Appropriate ECD Application: The nursing team was educated on appropriate assessment of male anatomy for ECD placement
• Measurement:– Before and after catheter
utilization and CAUTI infection ratesIncreased adherence to best
• Foley Catheter Appropriateness Criteria: Benign prostatic hypertrophy; neurogenic bladder; stage 3 and 4 sacral pressure injury; and strict I&O
• ECD Appropriateness Criteria: No restraints; no neurogenic bladder; no benign prostatic hypertrophy; and cooperative with no urinary issues
• ECDs were contraindicated:– Patient was unable to void or had
known urinary retention– Unhealed wound on glans penis– Active inflammation or infection
of the glans, foreskin or urethra
46% ↓
Average wear time: 48-72hrsZero Male CAUTI’s During Intervention
Alternative Female External Collection Devices
• How do they work?– They are placed between the
labia and the urethral opening– The devices are attached to wall
suction– When female voids, the urine
flows thru the fabric into the collection chamber at the distal end, the suction takes the urine to the collection container
Quality Improvement Project
• 18 bed adult SICU• 10 month pre/post QI study• Utilization of an external
female collection device • Daily rounds discussion
– Inter-professional discussion regarding indications
• Avoid placement • Early removal
• Measurement: CAUTI & SIR rates
Beeson T, Davis C & Vollman K. Presented at the NACNS Meeting in Austin Tx, March 2, 2018
Pre/Post Comparison Using Female External Device
Before After
CAUTI Rate 2.55 0.7
Standardized Infection Ratio (SIR)
1.395 0.381
IndwellingCatheter Days
↓ 9%
CDC, SHEA, IDSA, and NHS: Indications for Placement of Indwelling Catheter• Perioperative use for selected surgical procedures• Urine output in critically ill patients• Management of acute urinary retention and urinary
obstruction• Assistance in pressure ulcer healing for incontinent
patients• At patient request to improve comfort (SHEA) or for
comfort during end of life care (CDC)
How-to Guide: Prevent Catheter-Associated Urinary Tract Infections. Cambridge, MA: Institute for HealthcareImprovement; 2011. (Available at www.ihi.org).
Types Of TreatmentsRequiring Close UO Monitoring
• Bolus fluid resuscitation• Vasopressors• Inotropes• High dose diuretics• Hourly urine studies to measure life threatening
laboratory abnormalities
Are you responding hourly to the patient’s urine output??
I & O in Critical Care
Beascher T. J Wound Ostomy Continence Nurs. 2014;41(6):604-
608.
The Culture of Culturing
Recommandations on Urine Culture Management • Establish a preculture strategy that directs efforts at
how cultures are ordered rather than solely addressing issues after a UA or UC test is finalized:– Modify the electronic medical record to include appropriate and
inappropriate indications for UAs/UCs that address patient symptomology
– Eliminate automatic orders in care plans where appropriate– Provide education for all clinicians who order UCs with
emphasis on appropriate indications for UCs and UTI symptoms in catheterized and non-catheterized patients
– Carefully evaluate patients with fever and order UCs as appropriate
– Reflex urine testing should be considered only if used in conjunction with careful clinical evaluation for signs and symptoms of UT
Modify Your EMR Ordering Process• Incorporated mandatory selection of standardized
indications in EMR for ordering a UC in catheterized patients: – Suprapubic pain/tenderness– Acute gross hematuria– Costovertebral angle tenderness– New fever/rigors with clinical assessment negative for more likely
etiology– Acute alteration of mental status with clinical assessment negative
for more likely etiology– Alteration in medical condition with clinical assessment negative for
more likely etiology in patient whom fever may not be a reliable sign– Increased spasticity or autonomic dysreflexia in patients with altered
neurologic sensation
Shirley D, et al. Infect Control Hosp Epidemiol 2017;38:486-88.
Lowers urine cultures and CAUTI rates
Recommandations on Urine Culture Management
• Measure % of patients treated with antibiotics for urinary tract infection with catheter and no documented signs or symptoms of clinical infection (ASB)
• Ensure proper collection and handling of urine specimens:– Replace catheters in symptomatic patients before collecting a
specimen– Delineate policies and procedures and educate personnel on
the proper methods to collect Ucs– Standardize the use of refrigeration or preservative tubes in
all health care settings, including ambulatory clinics and EDs.
Garcia, R & Spitzer ED. American J of Infect. Control. Am J Infect Control. 2017;45(10):1143-1153.Health Research & Educational Trust (2017). : 2017. Chicago, IL: Health Research & Educational Trust. Accessed at www.hret-hiin.org
Example: St Joseph Mercy Hospital Urine Culturing Tool
Alternate Approach: Focus on Ordering Not Test Result (Pts w/IUC)• KICKING CAUTI Campaign, study at 2 Veterans
Affairs health systems• One multifaceted intervention vs one comparison site
Trautner BW. JAMA Intern Med 2015;175:1120-27.
Urine Cultures ↓ by 71%
ASB Tx ↓ by 75%CAUTI Tx ↓ by 89%
Antibiotic Stewardship
• Program that promotes appropriate selection, dose, route and duration of antimicrobial therapy– Primary goal: optimize clinical outcomes while reducing
unintended consequences of antimicrobial use• Toxicity• colonization of pathogenic organisms• Antibiotic resistance
– Secondary goal: reduce health care costs associated with diseases such as CDI and antimicrobial resistance.
• Comprehensive programs both large & small hospitals shown ↓ in antimicrobial use between 22%-36% with annual savings of $200,000 to $900,000.
Health Research & Educational Trust (2017). Clostridium difficile Infection Change Package: 2017 Update. Chicago, IL: Health Research & Educational Trust. Accessed at www.hret-hiin.org.
Horizontal Approach: It Works
• Retrospective, observational study in the surgical ICU of a tertiary care medical center in Boston, MA, from 2005 to 2012
• N=6,697 patients in the surgical ICU
Traa MX, et al. Crit Care Med 2014; 42:2151–2157
↓21% per yearSince 2008 Zero MRSA infections
It is not enough to do your best; you must know what to do, and THEN do your best.
~ W. Edwards Deming
Bug Out
Contact Kathleen Vollman atkvollman@comcast.net
www.Vollman.com
https://www.medbridgeeducation.com/advancing-nursingHAI prevention courses by Kathleen Vollman
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