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3M Global I.V. Summit Introduction - 2013
 

3M Global I.V. Summit Introduction - 2013

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Dr. Parks

Dr. Parks

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  • There is a conventional wisdom that mortality from catheter related bloodstream infection is approximately 5%. However, large studies have shown that the actual mortality rate is closer to 15% or one patient in 7. In a single small study from China, the mortality was 25% higher in patients with CRBSI. These data indicate, that worldwide, even in the most experienced countries, the mortality rate is much higher than is typically believed.
  • Historically, central venous catheter infections have been considered as the most important feature of extended us of a cvc line. Securement, or more appropriately, the lack of securement has been considered the key feature of peripheral catheter use.………….click……….However, current evidence over the last year and one-half has indicated that there is a convergence of problems and that securement is important for cvc lines while awareness of infections of peripheral lines is increasing. 3M’s dressings are capable of improved securement as well as functioning as a barrier to organisms by virtue of its design. Patient safety is enhanced by the combination of improved securement that results in extended wear for the dressings. In the case of Tegaderm CHG, the ability to release CHG from a 2% CHG gel allows for continued suppression of bacteria.

3M Global I.V. Summit Introduction - 2013 3M Global I.V. Summit Introduction - 2013 Presentation Transcript

  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.Leading change in a cost constrained environmentPatrick J Parks MD PhDMedical Director, 3M Critical & Chronic Care Solutions DivisionAdjunct Associate Professor, Dept of Clinical & Experimental Pharmacology, University of Minnesota
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.2Global IV Summit:outline for conferenceReviewCurrent StatusSummit Program
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.3 Argentina Australia Brazil Canada China Ecuador El Salvador India…..maintaining the nature of a „global‟ summit… Saudi Arabia South Africa Spain Sweden Thailand United Arab Emirates United Kingdom United States Japan Jordan Lebanon Mexico New Zealand Philippines Poland Russia
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved. 4PolicyGuidelinesPatientgroupsOutcomesClinicalpracticePracticeprotocolsCDC, EPIC2,WHO, RNAOClinical studiesRCT,InterventionalDRG, PGDIHI bundles. SavingLives, CUSPSafer HealthcarenowTechnologies:Antiseptics, dressings,catheters, vessel health,ultrasound placementPreclinical expts:PFGEMicroarraysStandardsof care(INS)EducationauditscompetenceGovernment(s)RegulatoryapprovalExperimentsNationalPatientMolecular2011 Global IV Summit
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.2011 Global IV Summit – Guidelines and Standards
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved. 6PolicyGuidelinesPatientgroupsOutcomesClinicalpracticePracticeprotocolsCDC, EPIC2,WHO, RNAOClinical studiesRCT,InterventionalDRG, PGDIHI bundles. SavingLives, CUSPSafer HealthcarenowTechnologies:Antiseptics, dressings,catheters, vessel health,ultrasound placementPreclinical expts:PFGEMicroarraysStandardsof care(INS)EducationauditscompetenceGovernment(s)RegulatoryapprovalExperimentsNationalPatientMolecular2012 Global IV Summit
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.The 4 “E”s of Implementation ScienceFarber M and Hanchett M, Success through implementation science: reducing HAIs in the ICU.Prevention Strategist, Winter 2011, 44-46.EVALUATE ENGAGEEXECUTE EDUCATEToolkits, reminders and learningfrom mistakesMeasure performanceExplain why intervention isimportant to front line staff andexecutivesShare the evidence
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.8Olmstead, R., “Where did Semmelweis go wrong in Leadership andFollowership?” 3M Global IV Leadership Summit, 25-27 April 2012.
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.9Global IV Summit:outline for conferenceReviewCurrent StatusSummit Program
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.Intravascular (IV) devices Short term (<10-14 days)– Peripheral IV catheters– Arterial catheters– Central venous catheters(CVC)• Non cuffed• Not tunneled Long Term (>10-14 days)– Subcutaneous central venousports– Peripherally inserted CVC(PICC)– Central venous catheters• Cuffed• TunneledIDSA guidelines 2009
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.11Attributable mortalityTacconelli E et al J Hosp Inf (2009) 72:97-103 France: 11% Germany: 12-15% Italy: 18%Worth LF et al Cancer (2007) 109:1215-1226. Australia: 12% (haematological malignancy)Wenzel RP and Edmond MB Emerg Inf Dis (2001) 7: 174-177 United States: 15% (estimated)Peng S and Lu Y J Critical Care (2012) http://dx.doi.org/10.1016/j.jcrc.2012.09.00.007 China: 52% (vs 28% without CRBSI)11
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.Problem convergencePERIPHERAL We estimate that there may beas many as 10,028 PVC-relatedS. aureus bacteremiasyearly in US adult hospitalizedinpatients. PVC-related S. aureusbacteremia is anunderrecognized complication.TT Trinh et al., Peripheral venous catheter relatedStaphylococcus aureus bacteremia. Infect ControlHosp Epidemiol. 2011 Jun;32(6):579-83.CENTRAL120.11101001st 2nd finalHazard ratioRisk of infection rises as thenumber of unintentional dressingchanges rises.Timsit JF, Bouadma L, Ruckly S, et al. Dressingdisruption is a major risk factor for catheter relatedinfections. Crit Care Med (2012) Apr 6 epub.
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.13Framing the problem:Problem convergenceInfectionCentral venous Peripheralcatheters cathetersSecurement13TT Trinh et al., Peripheral venous catheter relatedStaphylococcus aureus bacteremia.Infect Control Hosp Epidemiol (2011) 32:579-83
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.14 Incremental cost per CRBSI:– $82 000 (in 2008 United States Dollars [USD])– 14 additional hospital days (12 in MICU)Cohen ER et al Cost savings from reduced catheter related bloodstream infection after simulationbased education for residents in a medical intensive care unit. Simul Healthc (2010) 5:98-102. Length of stay and cost per CRBSI: case control study– Length of stay WITH CRBSI – 16 days vs 5 days WITHOUTCRBSI– Weighted mean total charges for patients:• WITH CRBSI $110 183• WITHOUT CRBSI $22 302– Total healthcare burden for CRBSI: $37.24 BILLIONOmar M. AL-Rawajfah OM et al., Length of stay and charges associated with healthcare acquiredbloodstream infections. Am J Infec Ctrl (2012) 40:227-242.Attributable morbidity:Cost & Duration of Hospitalization
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.15The problem: confluence of immutable forces15Increased insured population =increased healthcare demandBaby Boomer impact - 2.8 million newMedicare beneficiaries each year!2010 Medicare pop.=47 million2011 projection = 49.8 million2030 projection = 80 millionHealth care spending is16% of GDP (2007)
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.16
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.17Support50%30%29%34%45%45%6%7%6%8%14%16%4%3%4%Strongly agree Somewhat agree Somewhat disagree Strongly disagree Not sureMy administration knowsthe extent to which CRBSIsare a problem at my facilityIt is clear who is incharge of preventingCRBSIs at my facilityMy administration is willingto spend the necessarymoney to prevent CRBSIs34%45%45%Olmstead, R., “Where did Semmelweis go wrong in Leadership andFollowership?” 3M Global IV Leadership Summit, 25-27 April 2012.
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.18Global IV Summit:outline for conferenceReviewCurrent StatusSummit Program
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.19Virtual summit (content in English)
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.20 Enhance leadership skills needed to advanceclinical practice. Share „best practices‟ in vascular access andinfusion therapy. Form a global network that extends wellbeyond the Summit.Summit objectives:
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.21Transforming Leaders. Transforming Care. Post-It® Notes have been placed on each table Please use them to capture transformationalmoments Place the Post-It® Note on one of the two easels atthe front of the room We‟ll share these on Friday
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.22 Day 1– Lectures (whole group)– Networking Day 2– Lectures (whole group)– Cultural exchange– Case study Day 3– Lectures (whole group)– NetworkingSummit Program
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.23 Economic capital Human capital (education) Cultural capital Social capital (benefits derived from cooperation)– Trust – honesty, reliability, consistency and caring2013 theme: “capital development”
  • Transforming Leaders. Transforming Care.© 3M 2012. All Rights Reserved.24Day 1: commonalities