Low or Middle Income= < $3705 gross national income per capita/per yearAs the economic status of a given population DECREASES, the significance and impact of HAIs on mortality INCREASESSocioeconomic conditions affect the quality of healthcare including infection preventionHealthcare capacity is affected by infrastructure, HCW training, patient knowledge and purchasing power
TRUE FOR MOST ANTIBIOTIC RESISTANCE EXCEPT VRE
In addition, MOST RESOURCE POOR COUNTRIES HAVE NO ENFORCEABLE LEGISLATION OR NATIONAL INFECTION CONTROL GUIDELINES AND NO ACCREDITATION PROGRAMSCORRELATION BETWEEN LACK OF REGULATION AND LOWER HH COMPLIANCEAlso many problems due to lack of staffing, over crowding, and lack of supplies all of which directly impact DA-HAI rates
EDUCATION DOES NOT EQUAL COMPETENCY AND TRAINING DOES NOT EQUAL EDUCATIONTraining is all too often liability protection and not competency validation.Lack of training/experience directly tied to increased DA-HAI ratesSurveillance – must be done – If you don’t do it, how do you know what you have.
WHAT DID YOU DO AND WHY?
CONCLUSIONThe Issues- Easy to IdentifyThe Solutions- Can be IdentifiedImplementation-Very difficult.REMEMBER THE ACRONYM- IEIEIE/Identify, Educate, Improve, Embed, Innovate, Empathize !!!
Universal Components of an IV Culture of Safety
Universal Components of an IVCulture of Safety3M IV Leadership SummitMay 15-17, 2013St Paul, MNRuss Nassof, JDEVPRiskNomics, LLC1
Conflict of Interest• Russ Nassof is a paid consultant to Becton, Dickinson andCompany2
Objectives• Define issues contributing to the disparity in device-associatedhealthcare-associated infection practices from nation tonation;• Identification of 6 key elements which can reduce disparityand form the foundation for establishment of a uniformculture of safety to prevent device-associated healthcare-associated infections; and,• Identification of critical risk exposure points for device-associated infections and how to manage those risks toeffectively create a universal IV culture of safety. 3
Prevention• Once it is established that an adverse healthcare event can be“PREVENTED”…• Best evidence based practices will be revised as necessary;• The standard of care (what another reasonably prudentprofessional would do in the same or similar circumstances)will change as necessary; and,• Liability can be imposed based on the failure to adhere to bestpractices and meet the standard of care.However… What Can Be Prevented in MinnesotaMay Not Be Reasonably Preventable in Mali 4
Diversity of Problems• Difficult to Find Commonality in the Prevention of Device-associated Healthcare-associated Infections (DA-HAIs) Acrossthe Globe5
Diversity of Problems• Difficult to Find Commonality…Disparity in Wealth- World Bank- 68% of World EconomiesRepresenting 75% of the World Population Identified as LowResource Countries6
Diversity of Problems• Difficult to Find Commonality…Disparity in Infection Control PracticeReporting/Collecting DataRegulations/AccreditationDefinitionsVariability in PracticePatient PopulationsSurveillanceHealthcare StructureResourcesHCW/Patient Ratios7
Diversity of Problems• Difficult to Find Commonality…Disparity in HAI Device-associated Rates- While the rate ofdevice use in low resource country ICUs is analogous or evenlower than that in the USA, device-associated HAIs rates andantimicrobial resistance rates are HIGHER8
Culture of Safety• What Doesn’t Work?Do NOT impose solutions- “ASK, don’t Tell”Healthcare Microcosm/GladwellPronovost/Rosenthal- CLABSI solutions that work in Lansingmay not work in LhasaDon’t include CHG in your bundle if povidone iodine is the onlyoptionDon’t require single patient rooms if you don’t have single patientbedsIncluding unattainable interventions in infection preventionbundles creates more problems than not having any bundles atall9
Culture of Safety• What Does Work –FINDING COMMONALITYASK- IDENTIFYFOCUS ON IV PRODUCT ISSUES-selection, technologyFOCUS ON IV PRACTICE ISSUES-insertion, maintenance, hygieneEDUCATION/COMPETENCYSOLICIT MULTIDISCIPLINARY INPUTKEEP IT LOCALKEEP IT SIMPLEKEEP IT ECONOMICAL10
Culture of Safety• What Does Work- FINDING COMMONALITYMAKE IMPROVEMENTSSIMPLEEASILY ATTAINABLEMUST BRING “VALUE”11
Culture of Safety• What Does Work-FINDING COMMONALITYEMBED IMPROVEMENTS-SUSTAINABILITYCOMPETENCYSTANDARDIZATION/UNIFORMITYMULTIDISCIPLINARY INVOLVEMENTBUNDLES/CHECKLISTSINCENTIVESDOCUMENTATIONCONSISTENCY (IMPROVEMENT)12
Culture of Safety• What Does Work-FINDING COMMONALITYINNOVATECONTINUOUS EVALUATION OF NEW PRODUCTS/PRACTICEIMPLEMENT WHEN REALISTICBE AWARE OF NEW RISKS CREATED13
Culture of Safety• What Does Work- FINDING COMMONALITYCOMMUNICATE/TEAMWORKCommunication problems in healthcare are considered to be aleading cause of medical errors and are often the root cause ofsentinel eventsMost medical errors result from a breakdown in communicationamong staff, physicians, and patientsPoor communication and lack of teamwork in the healthcarearena have been identified as major causes of errors leading topatient morbidity and mortality14
Culture of Safety• What Does Work-FINDING COMMONALITYAPOLOGIZE (when mistakes are made)EMPATHY VS. ADMISSION OF FAULT/LIABILITYASSURANCE THAT MISTAKE WILL NOT RECURVOW TO DO BETTER IN THE FUTURESINCERITYTIMINGTRANSPARENCYIN PERSON/IN PRIVATE/ENGAGEDDOCUMENT 15
Culture of Safety• What Does Work-Finding Commonality• Critical Risk Exposure Points for Device-associated InfectionsEducation/CompetencyInsertionMaintenanceResponding to Adverse EventsIncorporating Technology16
Risk Exposure Points• Education/CompetencyWhat standards/policies/practices are being followed and why?Are written policies in place reflecting those standards? If yes- do those policies adhere to the standards? If yes, do practices comport with the written policies? If no, do practices comport with the standards adopted?Is training/education provided to applicable HCPs on policies?Are appropriate products/devices/ medications available to meetpolicy requirements?Are inappropriate products/devices/medications available?Are controls in place to ensure compliance?Are competency evaluations performed?Is Surveillance performed?17
Risk Exposure Points• Responding to Adverse EventsPeriodic site assessmentCriteria for response and procedural next stepsCriteria for removal of deviceCriteria for dressing change20
Risk Exposure Points• TechnologyProduct innovationPractice innovationDevice securementAntimicrobial dressing/devices• Technological innovation may result in shifting preventabilityand may also create new areas of risk.21
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