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HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
HAI Compendium
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HAI Compendium

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  • 1. The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals Infection Prevention and Control Advisory Committee November 19, 2008 Clare Kioski, MPH, CIC
  • 2.  Infection Control and Hospital Epidemiology; October 2008, Vol. 29. Supplement 1  http://www.shea- online.org/about/compendium.cfm
  • 3. Compendium Partners  Society for Healthcare Epidemiology of America (SHEA)  Infectious Disease Society of America (IDSA)  The Joint Commission  Association for Professionals in Infection Control and Epidemiology (APIC)  American Hospital Association
  • 4. Compendium Endorsers  American Organization of Nurse Executives (AONE)  Association for Respiratory Care (AARC)  Infusion Nurses Society (INS)  Pediatric Infectious Disease Society (PIDS)  Society for Critical Care Medicine (SCCM)  Society for Hospital Medicine (SHM)  Surgical Infection Society (SIS)
  • 5. Compendium Supporters  AARP  Academy Health  Agency for Healthcare Research and Quality (AHRQ)  American Academy of Emergency Physicians  American Association of Critical Care Nurses  American College of Physicians  American College of Surgeons  American Medical Association  Cardinal Health  Centers for Disease Control and Prevention (CDC)  Council of State and Territorial Epidemiologists (CSTE)  HCA Health System  Healthcare Infection Control Practices Advisory Committee (HICPAC)  Institute for Healthcare Improvement (IHI)  International Society for Microbial Resistance (ISMR)  National Foundation for Infectious Diseases (NFID)  National Quality Forum (NQF)  Premier, Inc.  Society of Infectious Diseases Pharmacists (SIDP)  Trust for America’s Health (TMAH)  United Healthcare  WellPoint Health Network
  • 6. Six Categories of HAIs  Two focused on Specific Organisms  Methicillin Resistant Staphylococcus aureus (MRSA)  Clostridium difficile infection (CDI)
  • 7. Six Categories of HAIs  Four Device-and Procedure-Associated  Central Line Associated Bloodstream Infections (CLABSI)  Ventilator Associated Pneumonia (VAP)  Catheter-Associated Urinary Tract Infection (CAUTI)  Surgical Site Infection (SSI)
  • 8. SHEA / IDSA Compendium  Compliments CDC guidelines  Includes metrics and indicators of success  Updated guidance in areas where official guidance is pending  SSI and UTI guidelines are in preparation  Format suitable for implementation in a clinical setting.
  • 9. Patient Guides  Developed by the SHEA Patient Safety and Quality Improvement Committee in collaboration with the Centers for Disease Control and Prevention (CDC) 
  • 10. Recommendation Format  Purpose  Rationale and Statements of Concern  Strategies to Detect  Strategies to Prevent  Recommendations for Implementing Prevention and Monitoring Strategies  Performance Measures
  • 11. Strategies to Detect  Surveillance Protocol and definitions  Use consistent surveillance methods and definitions to allow comparison with benchmarkdata  Refer to the National Health and Safety Network (NHSN) Manual: Patient Safety Component Protocol
  • 12. Strategies to Prevent  Existing guidelines and recommendations  Infrastructure requirements  Practical approaches
  • 13. Recommendations for Implementing Prevention and Monitoring Strategies  Basic Practices  Special Approaches  If rates are still high despite implementation of basic practices  Approaches that should NOT be considered  Unresolved issues
  • 14. Performance Measures  Internal Reporting  Process Measures  Outcome Measures  External reporting  State and federal requirements  External quality initiatives
  • 15. Strength of Recommendation and Quality of Evidence
  • 16. Prevention of Central Line Associated Bloodstream Infections (CLABSI)  Rationale and Statements of Concern  Increased length of hospital stay  Increased Cost  $3,700-$29,000 per episode  Risk Factors  Prolonged hospitalization before catheterization  Prolonged duration of catheterization  Heavy microbial colonization at insertion site  Heavy microbial colonization of catheter hub
  • 17. Prevention of Central Line Associated Bloodstream Infections (CLABSI)  Strategies to Detect  Use NHSN Criteria  Bloodstream infection (BSI)Definition  Central Line Definition  Denominator Description
  • 18. Prevention of Central Line Associated Bloodstream Infections (CLABSI)  Strategies to Prevent  Existing Guidelines & Recommendations  Healthcare Infection Control Practices Advisory Committee (HICPAC)  Institute for Healthcare Improvement (IHI)  Agency for Healthcare Research and Quality (AHRQ)  Infrastructure Requirements
  • 19. Prevention of Central Line Associated Bloodstream Infections (CLABSI)  Strategies to Prevent  Practical Implementation  Educate physicians, nurses, and other healthcare personnel  Develop and implement catheter insertion checklist  Establish catheter insertion kits/carts
  • 20. Prevention of Central Line Associated Bloodstream Infections (CLABSI)  Basic practices for prevention and monitoring  Before Insertion  Educate HCW on insertion, care and maintenance of central venous catheters  At Insertion  Use checklist to ensure adherence “bundle”  Hand Hygiene (even when gloving)  Avoid femoral veins  Use all inclusive central line carts/kits  Maximal barrier precautions  Use chlorhexidine-based antiseptic for skin prep
  • 21. Prevention of Central Line Associated Bloodstream Infections (CLABSI)  Basic practices for prevention and monitoring  After insertion  Disinfect catheter hubs, needleless connectors, and injection ports before accessing catheters with alcoholic chlorhexidine preparation or 70% alcohol  Remove non-essential catheters  Assess daily during multidisciplinary rounds  Change transparent dressings and perform site care with a chlorhexidine-based antiseptic every 5-7 days; change gauze dressings every 2 days
  • 22. Prevention of Central Line Associated Bloodstream Infections (CLABSI)  Basic practices for prevention and monitoring  After insertion  Replace administration sets not used for blood or lipids not longer than 96 hours  Use antimicrobial ointments for hemodialysis catheter insertion sites.
  • 23. Prevention of Central Line Associated Bloodstream Infections (CLABSI)  Basic practices for prevention and monitoring  Perform surveillance for CLABSI  Report data to units, physician and nursing leadership, and administration  Compare rates with national NHSN rates
  • 24. Edwards JR et.al. National Healthcare Safety Network (NHSN) Report, data summary for 2006-2007, issued November 2008.. Am J Infect Control 2008; 36:609-26
  • 25. Prevention of Central Line Associated Bloodstream Infections (CLABSI)- Special Approaches  Lack of effective control despite implementation of best practices.  Bathe ICU patients with a chlorhexidine preparation on a daily basis  Use antiseptic- or antimicrobial- impregnated central venous catheters for adult patients  Use antimicrobial locks for central venous catheters
  • 26. Prevention of Central Line Associated Bloodstream Infections (CLABSI) Approaches NOT recommended  Antimicrobial prophylaxis for short-term or tunneled catheter insertion  Replace Central venous catheters routinely  Use Positive-Pressure Needleless connectors with mechanical valves before a thorough assessment
  • 27. Updating the Compendium  SHEA/APIC/IDSA Standards and Practice Guidelines Committee will determine the need for revisions on the basis of examination of current literature at annual intervals.

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