Washington State Hospital AssociationPartnership for Patients

Safe TableReducing Hospital Acquired Infections

July 31, 2013

Amber Theel, Director Patient Safety

Presented at Washington State Hospital Association Safe Table, July 31, 2013

Partnership for Patients

• 40 – Percent reduction in harm

• 20 – Percent reduction in readmissions

• 13 – By December 2013

Saving Lives

2Presented at Washington State Hospital Association Safe Table, July 31, 2013

10 Targeted StrategiesInfection Reduction:

1. Catheter-associated urinary tract infections (CAUTI)

2. Central line-associated blood stream infections (CLABSI)

3. Surgical site infections (SSI)

4. Ventilator-associated pneumonia (VAP)

Nursing Care:

5. Injuries from falls and immobility

6. Pressure ulcers

High Risk:

7. Adverse drug events

8. Obstetrical adverse events

9. Venous thromboembolism or blood clots (VTE)

Continuity of Care:

10. Prevention of readmissions

Cultural Transformation

Leadership Engagement

Patient and Family Engagement

3Presented at Washington State Hospital Association Safe Table, July 31, 2013

Submission rates for most recent quarter:

CLABSI: 84.8%

VAP: 92.4%

CAUTI: 86.4%

SSI: 87.5%

Falls: 69.2%

Pressure Ulcers: 90.5%

EED: 92.1%

VTE: 81.1%

Readmission: 100.0%

ADE: 35.8%

Leadership, Patient and Family: 64.2%

  

Goal 40%

Goal 20%

Below the Line is Better

OBCLABSI VAP CAUTI SSI ADEReadmissionsPressure

UlcersFalls

40%

24%38%

18%

54%

82%

33%

Baseline2010

VTE

Based on submitted data through Q1 2013 for CLABSI and CAUTIBase on submitted data through Q4 2012 SSI, OB, and Falls Based on submitted data through Q3 2012 for Readmissions, VTE, and Pressure UlcersBased on submitted data through March 2013 for ADE

4%

Achieve by

December 2013

Harm and Readmissions Reduction Results

37%

Green – Reached GoalYellow – Moving in Right DirectionRed – Work to be Done

7/9/2013

28%

Presented at Washington State Hospital Association Safe Table, July 31, 2013

1. Obstetrical Adverse Events - EED plus Safe Deliveries Roadmap

2. Readmissions - Care transitions standardization

3. CAUTI - Monthly support for hospitals with high rates Dr. Sanjay Saint, Dr. Tim Dellit, and Carol Bradley, RN

4. CLABSI - Action Bundle plus high rate support5. VAP - Action Bundle plus high rate support

6. SSI - Action Bundle plus glycemic control7. VTE - Action Bundle8. Falls - Execution of leading practices9. Pressure Ulcers - Risk assessment,

prevention, early identification and treatment

10. ADE - Action Bundle

Global Strategies• Monthly reports to hospitals plus transparency• Engagement: leadership, patient, and family • Culture

Washington State Hospital Association

Safety Net AssessmentMedicaid Quality Incentive

Infection Control Measures

6

Presented at Washington State Hospital Association Safe Table, July 31, 2013

Washington State Hospital Association

Selected Measures: Acute, Rehabilitation, and Pediatric Services

Infection PreventionImprovement Measure - Catheter-Associated Urinary Tract Infections Per Patient Day (Hospital-wide)

Sustaining Measure -Health Care Personnel (HCP) Influenza Vaccination

Presented at Washington State Hospital Association Safe Table, July 31, 2013

Presented at Washington State Hospital Association Safe Table, January 31, 2013 11

Denominator categories: • All employee HCP: Includes both full-time and part-time HCP

employees• Non-employee HCP: Licensed independent practitioners

(physicians, advance practice nurses, and physician assistants) • Non-employee HCP: Adult students/trainees and volunteers

Numerator categories: • Influenza vaccinations• Medical contraindications• Vaccinations outside facility• Declinations• Unknown status

*Facilities are required to report all numerator categories for the three denominator categories

Flu Immunization Required Reporting

Presented at Washington State Hospital Association Safe Table, January 31, 2013 9

2012-2013 HCP Influenza Vaccination Rates 87.58%

Visitor Restrictions During Flu Season

Special restrictions or screening during respiratory/flu season in high risk populations?

• OB, Women and Newborn, NICU and pediatric facilities.  • How often are facilities screening visitors for illnesses? • How do you identify when patients have been screened?• Criteria for restrictions?

• Age, relationship to patient? 

State Reporting Hospital Acquired InfectionMeasures Old State Law New State Law CMS

Central line-associated bloodstream infections (CLABSI)

YES(ICU only)

YES(All inpatient areas)

YES (ICU only)

Ventilator-associated pneumonia (VAP) YES NO NO

Deep sternal wound for cardiac surgical site infections

YES YES(until 2017)

NO

Total hip replacement surgical site infections YES YES(until 2017)

NO

Total knee replacement surgical site infections YES YES(until 2017)

NO

Vaginal hysterectomy surgical site infections YES NO NO

Abdominal hysterectomy surgical site infections YES YES YES

Colon surgical site infections NO YES YES

Presented at Washington State Hospital Association Safe Table, July 31, 2013

Ventilator Associated Pneumonia (VAP)

• 250,000 VAP in 2002 – 36,000 associated with death.

• 3525 VAP reported in NHSN in 2011• Rates varied by type of unit 0.0 to 4.9 per 1000 ventilator days.

Presented at Washington State Hospital Association Safe Table, July 31, 2013

How will your facility measure VAP?

MDRO - Challenges

States, Federal, consumer groups, etc., displaying disparate public HAI metrics and formats

Inter-facility communication not standardized for multidrug-resistant organisms (MDRO) & HAI history

Practices across labs not standardized C. difficile infection (CDI) poorly understood, requiring

uniform surveillance MRSA infection high burden, high morbidityRise in MDROs, lack of standardized surveillance of

antimicrobial usage

Presented at Washington State Hospital Association Safe Table, July 31, 2013 9

Questions?10Presented at Washington State Hospital Association Safe Table, July 31, 2013