Preventing “healthcare associated infections” -is it knowledge deficit or culture??? Let's Explore

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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.

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Preventing “healthcare associated infections” -is it knowledge deficit or culture??? Let's Explore

  1. 1. Krish Sankaranarayanan MS, MBA, CPHQ Senior Safety Officer, Tawam Hospital. UAE
  2. 2. Introduction-About me • • • • • 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. 3. Introduction-About me…Contd • Membership – – – – – 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 – – – 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
  4. 4. Pledge
  5. 5. Items for discussion • Ice breaker – Video: Capt. Chesley "Sully" Sullenberger • Why is healthcare unsafe? – Healthcare Associated Infections Definitions – Facts and figures • Tools & Techniques to prevent Healthcare Associated Infections 2013-10-18 5
  6. 6. Ice- breaker Capt. Chesley "Sully" Sullenberger- Video
  7. 7. 2013-10-18 7
  8. 8. Hippocratic Oath 5th century BC -Physicians and other healthcare professionals swearing to practice medicine honestly
  9. 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. 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. 11. How is it that aviation became safer than healthcare ???
  12. 12. High Reliability Organizations Zero compromise to safety
  13. 13. So……Why is healthcare unsafe?
  14. 14. 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
  15. 15. Healthcare Associated Infections- HAIs
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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/
  20. 20. 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
  21. 21. Dangerous environment Spread of infection- Video
  22. 22. Tools & Techniques To Prevent Healthcare Associated Infections
  23. 23. Accreditation programs -Seeking gold standards
  24. 24. Patient Safety Goals
  25. 25. Technology support Hand sanitizer dispenser Sharps disposal box
  26. 26. 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/
  27. 27. Are these tools and techniques sufficient to prevent & eliminate HAIs?
  28. 28. Building a Culture of Safety 2013-10-18 33
  29. 29. 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 34
  30. 30. Twelve CUSP units 2013-10-18 35
  31. 31. 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 36
  32. 32. 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
  33. 33. 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.
  34. 34. Lessons from aviation- Use of checklists
  35. 35. Central line insertion checklist
  36. 36. Central line maintenance checklist
  37. 37. Electronic Checklist
  38. 38. Other techniques • Chlorhexidine Bathing • Chlorhexidine Impregnated Sponges and Antisepctic Coated Catherters.8 • Alcohol-impregnated disinfection caps 8Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheterrelated infections in critically ill adults: a randomized controlled trial. JAMA 2009;301:1231–1241
  39. 39. ICU -VAP & CLABSI Ventilator Associated Pneumonia -ICU Infections/1000 device days 20 18 16 14 12 10 8 6 4 2 0 ICU Average Rate for VAP Bundle Compliance 17.3 5.5 4.2 5.3 2.3 2006 2007 2 2008 2009 2011 2010 1.8 2012 97 96 95 94 93 92 91 90 89 88 96 91 2011 Ventilator Associated … ICU Average Rate for CVL Bundle Compliance Infections/ 1000 device days Central Line Associated Blood Stream Infections - ICU 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 0.8 0.7 2012 93 94 92 90 0.5 88 86 86 84 82 2010 2011 2012 Rate/1000 device days 2011 2012
  40. 40. NICU -VAP & CLABSI Ventilator Associated Pneumonia -NICU 1.2 7 6 1 0.8 0.6 0.3 0.2 0 0 Infections/1000 device days Infections/1000 device days 1 0.4 Central Line Associated Blood Stream Infections -NICU 6 5.9 5 3.6 4 3 2 1 0 2009 2010 year 2011 2009 2010 year 2011
  41. 41. Following High Risk Industry Model Replicating the same for CLBASI Free Days
  42. 42. NNU CLABSI Free Days 48
  43. 43. PICU CLABSI Free Days 49
  44. 44. ICU CLABSI Free Days CUSP Team with the ICU Executive - COO 50
  45. 45. PICU & ICU- CLABSI Free Days
  46. 46. CLABSI- Conversation tool 9, 10 1. 2. 3. 4. 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
  47. 47. CLABSI- Conversation tool……contd • To increase staff awareness • To ensure staff active involvement • To ensure conscientious implementation
  48. 48. “I Watch The Line” Campaign- Video
  49. 49. Opportunities for improvement “I Watch The Line”- Campaign • To increase staff awareness • To ensure staff active involvement • To ensure conscientious implementation ICU NNU PICU 56
  50. 50. CLABSI Badge Competition
  51. 51. Discussions- Simple strategies
  52. 52. 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
  53. 53. Five moments of hand hygiene
  54. 54. Complete the pledge
  55. 55. Thank You Email- ksankara@tawamhospital.ae Cell # 050 9211649

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