Infections Quality Improvement NURS 362 Cody Gibo Sylvia Lee Meagan Kubo Janalynn Rollins Summery of Problems HAIs are a major problem because ID: 792952
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Slide1
Reducing Health Care Associated Infections
Quality Improvement
NURS 362 Cody Gibo
Sylvia Lee
Meagan
Kubo
Janalynn Rollins
Slide2Summery of ProblemsHAI’s are a major problem becausethey increase length of stay, rates of patient morbidity, and cost the hospitals $33 billion per year (ASTHO, 2011)
Hospital-acquired infections are associated with 90,000 preventable deaths of patients annually (Fox et al, 2015)
www.
m
arietta.edu
Slide3Summary of Problems(continued…)
Processes…
- Poor adherence
- Insufficient resources
- Inadequate staffing
- No desire to change
- Improper staff and
patient education
(Flanagan et al, 2011)
Key Players
- Physicians- Nurses- PT/OT- Nurses aids- Housekeepers- Patients- Visitors
PICOT Population/Patient Problem: Pt’s w/HAI, at risk for HAI, (i.e. central lines,catheters, ventilator, post-op, immunosuppressed)
w
p.hepb.org
Slide4HAI’s in Hawaii vs. National Indicators
http://www.cdc.gov/hai/pdfs/stateplans/factsheets/hi.pdf
Slide5QI Tools for Root CauseAnalysis
3 Step Study
(Fox, et al, 2015)
Open ended question survey among hospital
collaboration
(Flanagan, et al, 2015)
www.cminstitute.net
Slide6Hand Hygiene Protocol from Hand Hygiene Study
Patient admitted to cardiac intensive care unit
Proceed w/intervention
Clean pt’s hands w/one 2 %
chlorhexidine wipe 3 times/day:
8am, 2pm, & 8pm
Document in medical record :
Yes, No (Why not)
Stop
Do not use
chlorhexidine
on patientIntensive care unit nurse: review welcome packet flyer on hand hygiene w/patient & patient family
Nursing assessment
Does patient have a
c
ontraindication to
c
hlorhexidine?
Does pt show signs
o
f drying, cracking,
o
r irritation?
Continue w/the intervention
as planned & assess hands w/
each application.
Study team will provide a
More thorough assessment
Continue w/the
Intervention as planned
& apply lotion 3 times/day
& as needed
Does pt continue
to have dry, cracked
or irritated hands that
do not improve w/lotion?
Contraindications to
c
hlorhexidine:
1. Allergy to chlorhexidine
2. Open wounds on hands3. Other indications
Alternative intervention:Clean pt’s hands w/step 1 foam & dry cloths3 times/day: 8 am, 2 pm& 8 pm
Continue w/the intervention as planned & applyLotion 3 times/day & as needed
NO
YES
NO
YES
NO
YES
Slide7Rates of Central Catheter-associated
Bloodstream Infection &
Catheter-associated Urinary Tract Infection
Slide8Recommendations to EliminateRoot Cause AnalysisEducate staff, patients, and caregivers (repeat correct demonstration of proper hand washing to the educator)
(F
ox et al, 2015)
Increasing certification activities across the spectrum of care (ASTHO, 2011)
Nurse lead/informatics lead interventions
(Bernard, Hunter & Moore, 2012)
Providing incentives for HAI prevention (ASTHO, 2011)
PICOTIntervention: Education training, certification, incentivesComparison: No treatment
Slide9Data Used to Evaluate SuccessLongitudinal study data (rates of infection before
and after tools implemented)
→
If rates go down;
evaluates success
PICOTOutcomes: Reduction in pt HAI casesTime: Varies but a particular study used was done in 5 yearswww.cambridgebrc.co.uk
Slide10ReferencesAssociation of the State and Territorial Health Officials [ASTHO]. (2011). Eliminating health
care associated infections. Retrieved from http://www.astho.org/hai_policy_toolkit/Bernard, M. S., Hunter, K. F., & Moore, K. N. (2012). A
review
of
strategies
to
decrease
the
duration of indwelling urethral catheters and potentially reduce the incidence of catheter-associated urinary tract infections. Urologic Nursing, 32 (1), 29-37.Centers for Disease Control. (2015). Healthcare associated infections progress: Hawaii. Retrieved from http://www.cdc.gov/hai/pdfs/stateplans/factsheets/hi.pdf Flanagan, M. E., Welsh, C. A., Kiess, C., Hoke, S., & Doebbeling, B. N. (2011). A national collaborative for reducing health care‒associated infections: Current initiatives, challenges, and opportunities. American Journal of Infection Control, 39 (8), 685-689. doi:10.1016/j.ajic.2010.12.013Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Jones, L., Bennett, Y. P., & ... Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital acquired
infections and improve nurses’
hand washing. American Journal of Critical Care, 24 (3), 216-224. doi:10.4037/ajcc2015898