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1. Healthcare-Associated Infections: The Bottom LineInsert LOGO
2. DISCLAIMER This document was developed by the Surveillance Subcommittee (SS) of the Arizona Healthcare-Associated Infection (HAI) Advisory Committee. SS is a multidisciplinary committee representing various healthcare disciplines working to define and categorize the strength of evidence for preventing healthcare-associated infections. Their work was guided by the best available evidence at the time this document was created.
3. SBAR ApproachSituation: One in 20 hospitalized patients in US acquire an HAI while receiving medical or surgical treatment. Limited resources for infection prevention hamper HAI prevention and elimination efforts.Background: With the burden of HAI disease increasing and new CMS non-reimbursement / value based purchasing (VBP) policies, there is now a need for change.
4. SBAR ApproachAssessment: Accurate and timely information is needed to monitor and implement HAI intervention strategies. Collecting, analyzing and reporting data into CDC/NHSN, to fulfill CMS mandatory requirements, require technical and personnel resources which are limited. Recommendations: Allocate resources to support infection prevention and patient safety. Implement evidence based practice and foster a culture of infection prevention.
5. AcronymsHealthcare Associated Infections (HAI)Value Based Purchasing (VBP)Surgical Care Improvement Project (SCIP)Surgical Site Infection (SSI)Central Line-Associated Bloodstream Infection (CLABSI)Ventilator-associated Event/Pneumonia (VAE/VAP)Catheter-associated Urinary Tract Infections (CAUTIs)Clostridium difficile Infection (CDI) National Healthcare Safety Network (NHSN)Multidrug-Resistant Organism (MDRO)
6. The HAI ProblemHAIs add billions of dollars to U.S. health care costsIn 2002, 1.7 million hospital-associated infections contributed to 99,000 deathsThe Harbarth study concluded that approximately 20 percent of all HAIs are probably preventable based on current medical practice and technologyHarbarth S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections: an overviewof published reports. J Hosp Infect 2003;54:258-266. Centers for Disease Control and Prevention: Press Release, March 2000. Available at: http://www.cdc.gov/od/oc/media/pressrel/r2k0306b.htm Klevens et al. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Reports. March-April 2007. Volume 122.
7. HAI Impact The health and safety of your patients!Direct medical costsIndirect costs ReimbursementPublic awareness factorLiability/litigationAccreditation and licensing factors
8. Impact of HAICentral line-associated blood-stream infections (CLABSI) $36,441 Surgical site infection (SSI) $25,546 Ventilator-associated pneumonia (VAP/VAE) $9,969Catheter-associated urinary tract infections (CAUTI) $1,006http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf
9. Heron et al. Natl Vital Stat Rep 2009;57(14). Available at http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdfAge-Adjusted Death Rate* for Enterocolitis Due to C. difficile*Per 100,000 US standard population00.51.01.52.02.519992003Rate200020042001200520022006YearMaleFemaleWhiteBlackEntire US population
10. Outcomes of C. difficile InfectionsExcess costs$2,380 to $3,240 per index hospitalization$3,797 to $7,179 inpatient costs over 180 days of follow-upOther outcomes2.8 days attributable excess length of stay19.3% attributable readmission (180 days)5.7% attributable mortality (180 days)More likely to be discharged to long-term careDubberke ER, et al. Clin Infect Dis. 2008;46:497-504.Dubberke ER, et al. 17th Annual Meeting of The Society for Healthcare Epidemiology of America (SHEA), April 14-17, 2007; Baltimore, MD. Unpublished data.
11. Hospital Charges for C. difficileHospital Discharge Database
12. National Data:Summary of HAI CostAnnual direct medical costs of HAI to U.S. hospitals $28.4 to $33.8 billion (after adjusting to 2007 dollars using the CPI for all urban consumers) $35.7 to $45 billion (after adjusting to 2007 dollars using the CPI for inpatient hospital services) Scott RD. The Direct Medical costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. CDC March 2009
13. What HAI Prevention SavesBenefits of prevention $5.7 to $6.8 billion (20 percent of infections preventable, CPI for all urban consumers) $25.0 to $31.5 billion (70 percent of infections preventable, CPI for inpatient hospital services) CPI = Consumer Price Index
14. The Bottom Line: HAI Prevention Needs to Start at the FrontlinesExecutive support Resource allocationTechnology transferPersonnel resourcesSuccession planning Shared resources including DE, DACollaborative relationships (HSAG, HRET-HEN, APIC, Skilled nursing facilities, health departments) Participation with collaborative performance improvement efforts Reward and acknowledge performance improvement efforts
15. The Bottom Line: HAI Prevention Needs to Start at the FrontlinesSurveillanceActivities result in improved patient safety Electronic technology for data retrieval and data transfer to NHSNImplementation scienceProcess for sustaining improvement efforts require resourcesReinforce “ no shortcuts” for evidence based initiativesMake change manageable = One person, one process at a timeImprovement is cyclical, forecast for future needs
16. Recommendations:What Should Be Done to Correct the Problem?Support Infection Prevention programElectronic Surveillance SystemAdequate staffing for surveillance activitiesReal Time Reporting to UnitsRounding
17. RecommendationsImplement house-wide device-related infection prevention bundleIntegrate “bundle” elements into electronic medical recordCheckbox for reason for deviceOnly include Reasons that are Evidence BasedDaily reminder to physicians to discontinue/continue indwelling catheter
18. RecommendationsSupport multi-disciplinary roundingSupport multi-disciplinary device-related infection teamCLABSI team, VAP team, CAUTI teamSupport antibiotic stewardship programsSupport Just Culture environmentNon compliance is reckless behavior
19. Questions?For more information about this topic, please visit: www.cdc.gov/hai/ www.azdhs.gov/phs/oids/hai/Surveillance.htmwww.wearepublichealth.org