Healthcare Associated Infections (HAIs) are the fourth leading cause of death in the USA. About 1.8 million patients suffer annually from care-related infections. HAIs cause 99,000 deaths every year in the US alone, at a cost of $3.1 billion dollars in excess healthcare costs in acute care hospitals. Besides HAIs kill more people than AIDS, breast cancer and auto accidents combined.
It is estimated that 271 people died each day from healthcare-associated infections (HAIs) such as Methicillin-resistant Staphylococcus aureus (MRSA) infections. Which is equivalent to one airline crash per day.
2. Introduction-About me
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Been in healthcare domain for over 24 years.
Triple Masters degree.
MS in Patient Safety Leadership from UOI- Chicago.
Certified Professional in Healthcare Quality (CPHQ)
Educational consultant- Canadian Healthcare
Association- Risk Management & CQI program
• Member Patient Safety Task Force- American Society
for Healthcare Risk Management
• 2009-Received $ 10,000 scholarship from IHI to attend
the Patient Safety Executive Development Program at
Boston.
• Noted regional and international speaker “Culture of
Safety” and “Disclosure of Medical Errors.”
3. Introduction-About me…Contd
• Membership
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Member American College of Healthcare Executives
Member National Association of Healthcare Quality
Member American Society for Healthcare Risk Management
Member American Society of Professionals in Patient Safety
Vice President of the ACHE Middle East and North Africa Group
• Publication
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Gurdeep S. Dhatt, Hassan Abu Damir, Steven Matarelli, Krishnan Sankaranarayanan, and
David M. James “Patient safety: patient identification wristband errors”. Clin Chem Lab Med.
2011 May;49(5):927-9. Epub 2011 Feb 3.
Krishnan Sankaranarayanan, Steven A. Matarelli, Hasrat Parkar, and Mamoon Abu Haltem
“From Blame to Fair and Just Culture: A Hospital in the Middle East Shifts Its Paradigm.”
PSQH. 2013 July/August; pg 30.
Krishnan Sankaranarayanan and Steven A. Matarelli, “Putting a SMILE on the Culture of
Safety frame work.” Arab Medical Hygiene 2013 October; pg 28
8. Hippocratic Oath
5th century BC -Physicians and other healthcare professionals swearing to
practice medicine honestly
9. Florence Nightingale -The founder of modern nursing
1863-“the very first requirement in a Hospital is that it should do the sick no
harm
10. Dr. Ernest Codman
1905 started "end result idea.“ Hospital standardization.
Doctors should follow up with all patients to assess the results of their treatment
and that the outcomes actively be made public.
11. How is it that aviation became safer than
healthcare ???
16. The patients saw an average of 17.8 health
professionals during their hospitalization1
1Whitt
N, Harvey R, McLeod G, Child S. How many health professionals does a patient see during an average hospital stay? NZMJ 4
May 2007; Vol 120 No 1253
18. Healthcare Associated Infection- Definition
• The World Health Organization
– Health care-associated infection (HCAI), also
referred to as "nosocomial" or "hospital" infection,
is an infection occurring in a patient during the
process of care in a hospital or other health care
facility which was not present or incubating at the
time of admission.
• Centers for Disease Control and Prevention
– Healthcare-associated infections (HAIs) are
infections that patients acquire during the course
of receiving treatment for other conditions within a
healthcare setting
19. FACTS And FIGURESU.S. Hospital-Acquired Infections
• HAIs are the fourth leading cause of death
in the USA.2
• 1.8 million patients suffer annually from carerelated infections.
• HAIs cause 99,000 deaths every year
• HAIs cost $3.1 billion dollars in excess
healthcare costs in acute care hospitals
alone.
• HAIs kill more people than AIDS, breast
cancer and auto accidents combined
2www.cdc.gov/ncidod/dhqp/healthDis.html
20. FACTS And FIGURES• 271 people died each day from healthcareassociated infections (HAIs) such as Methicillinresistant Staphylococcus aureus (MRSA) infections.
• Equivalent to one airline crash per day
21. World Health Organization
• WHO estimates that HAIs results in3
– Prolonged hospital stays
– Long-term disability
– Increased resistance of microorganisms to
antimicrobials
– Massive additional costs for health
systems
– High costs for patients and their family,
and
– Unnecessary deaths.
3http://www.who.int/gpsc/country_work/burden_hcai/en/
22. Healthcare Associated Infection- HAI
• Central line Associated Blood Stream
Infection- CLABSI
• Surgical Site Infection-SSI
• Cather Associated Urinary Tract
Infection-CAUTI
• Ventilator Associated Pneumonia -VAP
31. Antimicrobial Stewardship
• Antibiotic stewardship refers to a set of
coordinated strategies to improve the
use of antimicrobial medications with
the goal of enhancing patient health
outcomes, reducing resistance to
antibiotics, and decreasing
unnecessary costs.
• The Infectious Diseases Society of America
(IDSA)
• http://www.antimicrobialstewardship.com/
32. Are these tools and techniques sufficient to
prevent & eliminate HAIs?
34. Johns Hopkins Medicine
Comprehensive Unit-based Safety Program (CUSP)
6-step safety program
Step 1: Safety Attitude Questionnaire (SAQ)
Step 2:Staff education on the Science of Safety
Step 3: 2-item Staff Safety Survey
▪ Please describe how you think the next patient in your unit/clinical area
will be harmed?
▪ Please describe what you think can be done to prevent or minimize this
harm?
Step 4: Executive Walk Rounds
Step 5:
a) Learning from defects
b) Improving teamwork and communication
Step 6 : Resurvey staff about Safety Culture (annually)
2013-10-18
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36. Culture linkages to Clinical, Operational & other
Outcomes4
•Wrong Site Surgeries
•Decubitus Ulcers
•Delays
•Bloodstream
Infections
•Post-Op Sepsis
•Post-Op Infections
•Post-Op Bleeding
•PE/DVT
•RN Turnover
•Absenteeism
•VAP
4Colla
•Burnout
•Unit size
•Communication
breakdowns
•Familiarity
•Spirituality
JB et al. 2005. “Measuring patient safety climate: a review of surveys.” Qual Saf Health Care, 14:364–366
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37. HAI- Central Line Associated Blood Stream Infection
(CLABSI)
• CLABSI
– Attributable mortality: 9-25%5
– Attributable cost: $25,000-$45,0006
– Of patients who get a bloodstream infection
from having a central line, up to 1 in 4 die.7
• CMS Medicare and Medicaid no longer pays
hospital for CLABSI
5Dumont,
C. & Nesselrodt, D. 2012. Preventing CLABSI: Central line-associated bloodstream infections. Nursing2012, 6.
N, Weinhold D, Tong E, et al. Effect of healthcare-acquired infection on length of hospital stay and cost. Infect
Control Hosp Epidemiol 2007;28:280–292.
7CDC Vital Signs. Making healthcare safer: reducing bloodstream infections. March 2011. Available at:
http://www.cdc.gov/VitalSigns/Issues.html
6Graves
38. CLABSI Prevention Techniques5
1. Wash Hands Prior to Procedure
2. Use Maximal Barrier
Precautions
3. Clean Skin with Chlorhexidine
4. Remove Unnecessary Lines
5. Avoid Femoral Lines
5Dumont,
C. & Nesselrodt, D. 2012. Preventing CLABSI: Central line-associated bloodstream infections. Nursing2012, 6.
52. CLABSI- Conversation tool 9, 10
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5.
What is the prevailing CLABSI rate in the unit?
What is the CLABSI rate goal for the unit?
Do providers routinely use head-to-toe drapes?
How many drapes were used to cover the patient from head -to-toe?
Does the unit have a guideline to remove femoral catheters as soon as
possible?
6. What is the level of compliance from providers?
7. Does the unit have guidelines to check on a daily basis whether lines can be
removed?
8. Does the unit have a central line insertion checklist? Do providers routinely
use the checklist?
9. Does the unit have a central line maintenance checklist? Do providers
routinely use the checklist?
10. When inserting a central line, do staff have access to line cart and
equipment’s that they need?
9Pronovost
PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation.
BMJ2008;337:963-5
10Tools for Reducing Central Line-Associated Blood Stream Infections. January 2012. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum- tools/clabsitools/index.html
53. CLABSI- Conversation tool……contd
• To increase staff awareness
• To ensure staff active involvement
• To ensure conscientious implementation
56. Opportunities for improvement
“I Watch The Line”- Campaign
• To increase staff awareness
• To ensure staff active involvement
• To ensure conscientious implementation
ICU
NNU
PICU
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59. Simple strategies to prevent Healthcare Associated
Infections
• Strict hand hygiene before and after contact with
each patient or their environment
• Adequate hand hygiene facilities for staff and
patients
• A clean hospital environment and good hygiene
practice
• Isolation of patients in single rooms, when
necessary, to reduce the risk of infection
• Careful prescription of antimicrobial drugs
• Training on infection prevention and control for all
staff