Practicum Presentation

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A brief, visual summary of my work with the Kentucky Hospital Association, to evaluate Infection Prevention programs throughout Kentucky.

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  • Introduce and thank Dr. Carrico & Elizabeth, Vice President of Health Policy for KHA.
  • Reportable Diseases such as Hepatitis B, HIV, Mumps, Foodbourne Outbreaks, etc.
  • As part of KY. MRSA Collaborative, project was undertaken to describe existing capabilities of infection preventionists throughout Kentucky. Survey results are being used to guide development and planning of education programs and other resources to support infection preventionists in hospitals and other settings.
  • National Meetings such as SHEA and APIC. Would like to see more support for education.
  • Poses major problem for rapid response.
  • National Healthcare Safety Network
  • NHSN used by only 9.6%
  • Practicum Presentation

    1. 1. An Evaluation of Infection Prevention and Control Programs in Kentucky Hospitals Jessica Young University of Louisville April 2009
    2. 2. Objectives <ul><li>Discuss incidence and severity of Healthcare Associated Infections (HAIs) in US hospitals. </li></ul><ul><li>Explain the purpose of the project. </li></ul><ul><li>Explain methods for developing and conducting the study. </li></ul><ul><li>Review results. </li></ul><ul><li>Discuss limitations of project and/or problems faced. </li></ul>
    3. 3. Current Reality <ul><li>March – April 2007 Public Health Reports </li></ul><ul><ul><li>In 2002, estimated HAIs in US = 1.7 million </li></ul></ul><ul><ul><ul><li>>33,000 in high risk nurseries </li></ul></ul></ul><ul><ul><ul><li>>19,000 in well-baby nurseries </li></ul></ul></ul><ul><ul><ul><li>>417,000 in ICUs (adults and children) </li></ul></ul></ul><ul><ul><ul><li>>1.2 million among adults and children outside ICUs </li></ul></ul></ul><ul><ul><ul><li>Klevins et al. Public Health Reports. Mar/Apr. 2007 </li></ul></ul></ul>
    4. 4. Current Reality <ul><li>Number of HAIs currently exceed number of cases of any reportable disease, causing major concern for public health professionals. </li></ul><ul><li>In the past, public health responses have primarily revolved around reportable diseases. </li></ul><ul><li>The nationwide cost to treat hospitalized patients infected with MRSA is estimated to be almost five billion dollars ($5,000,000,000). </li></ul><ul><li>http://www.healthwatchusa.org/mrsa/index.html </li></ul>
    5. 5. Project Purpose <ul><li>To develop and distribute a web-based survey to the identified Infection Preventionists in Kentucky’s 126 hospitals. </li></ul><ul><li>Analyze the results. </li></ul><ul><li>Provide a descriptive summary of those programs back to the Kentucky Hospital Association and the Kentucky hospitals. </li></ul><ul><li>Results will be used to guide development and planning of education programs. </li></ul>
    6. 6. Survey and Commitment <ul><li>Hospital infection prevention survey </li></ul><ul><ul><li>Distributed via web-based format (Zoomerang). </li></ul></ul><ul><ul><li>Sent to all 126 Kentucky hospitals. </li></ul></ul><ul><ul><li>114 hospitals responded (90.4%). </li></ul></ul><ul><ul><li>160 total Infection Preventionists in those 114 hospitals. </li></ul></ul><ul><ul><li>Guide future activities for providing education and resources. </li></ul></ul>
    7. 7. Survey Purpose <ul><li>Identification of the educational and work experience of the Commonwealth’s Infection Preventionist (IP) community. </li></ul><ul><li>Evaluation of the programmatic elements of the infection prevention department/function. </li></ul><ul><li>Evaluation of surveillance methodologies compared with the National Healthcare Safety Network (NHSN) gold standard. </li></ul>
    8. 8. Methods <ul><li>Review of similar surveys conducted by other states. </li></ul><ul><li>Survey used by the New York Department of Public Health and Mental Hygiene was chosen as model for the “Evaluation of Infection Prevention and Control in Kentucky Hospitals.” </li></ul><ul><li>Web-based survey developed in Zoomerang (online survey tool). </li></ul><ul><li>Survey tested by KHA, then distributed to Infection Preventionists in Kentucky’s 126 hospitals. </li></ul>
    9. 9. Methods <ul><li>Surveys were electronically disseminated on October 31, 2008. </li></ul><ul><li>Regular reminders were sent by e-mail and phone until survey was closed on January 24, 2009. </li></ul><ul><li>Survey analysis was conducted by U of L student and faculty, using Microsoft Excel and Zoomerang. </li></ul><ul><li>Written report was provided to the KHA. </li></ul>
    10. 10. Questions we Asked <ul><li>Which Infection Prevention surveillance software is used in your facility? </li></ul><ul><li>Is the majority (>50%) of your surveillance done prospectively or retrospectively? </li></ul><ul><li>Are you available for contact 24/7/365? </li></ul><ul><li>Years of experience? </li></ul><ul><li>Level of education? </li></ul>
    11. 11. Experience An Evaluation of Infection Prevention and Control in Kentucky Hospitals . J. Young, R. Carrico, E. Cobb
    12. 12. Education An Evaluation of Infection Prevention and Control in Kentucky Hospitals . J. Young, R. Carrico, E. Cobb.
    13. 13. Evaluation of IP Program <ul><li>39 of the 114 (34%) responding hospitals have a designated healthcare epidemiologist, most being board-certified infectious disease physicians. </li></ul><ul><li>The infection prevention function is aligned most often with either the Quality or Nursing department. </li></ul><ul><li>Less than 20% of the IPs have been provided educational support to attend national meetings during past 2 yrs. </li></ul>
    14. 14. IP Program <ul><li>31% of the IPs are responsible for their hospital and at least one long term care facility. </li></ul><ul><li>52% are also responsible for at least one ambulatory care setting. </li></ul><ul><li>51% are available 24/7/365. </li></ul><ul><li>49% have no coverage when they are off or unavailable. </li></ul>
    15. 15. Surveillance Program <ul><li>NHSN is used as the surveillance software process by only 11 of the 114 (9.6%) of the responding hospitals. </li></ul><ul><li>47% of the IPs perform real-time surveillance as opposed to reviewing historic data. </li></ul><ul><li>47% of the reporting hospitals perform whole house surveillance. </li></ul><ul><li><50% of the IPs report that they use gold standard surveillance definitions for their reporting of HAI rates . </li></ul>
    16. 16. Surveillance Program <ul><li>Monitoring of microbiologic results for MDRO surveillance are performed by all hospitals. </li></ul><ul><li>Process of care measures are consistently monitored in most hospitals. </li></ul><ul><ul><li>Hand hygiene monitoring occurring in 100% of reporting hospitals </li></ul></ul><ul><ul><li>Central line insertion monitoring by 68% of reporting hospitals </li></ul></ul><ul><ul><li>Antibiotic prophylaxis monitoring in 81% of reporting hospitals. </li></ul></ul>
    17. 17. Conclusions <ul><li>IP workforce lacks richness of experience with almost half being in the field for 5 yrs. or less. </li></ul><ul><li>Almost all IPs are nurses. </li></ul><ul><li>Limited educational support. </li></ul><ul><li>NHSN gold standard for surveillance system and NHSN/CDC definitions are gold standard for surveillance process but application of this surveillance system and method is poor (only 9.6%). </li></ul>
    18. 18. Limitations <ul><li>Although response rate was positive, 90.4%, approximately 10% of hospitals did not respond, therefore they were not included in results. </li></ul><ul><li>Most of the questions were multiple choice, leaving respondents limited options to provide clarification. </li></ul><ul><li>Comparison with New York Survey is underway. </li></ul>
    19. 19. Thank You! <ul><li>For more information about the MRSA Collaborative, including the survey, please visit the KHA website at… </li></ul><ul><li> http://info.kyha.com/MRSA </li></ul>

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