The Compendium of
Strategies to Prevent
Healthcare-Associated
Infections in Acute Care
Hospitals
Infection Prevention and ...
 Infection Control and Hospital
Epidemiology; October 2008, Vol. 29.
Supplement 1
 http://www.shea-
online.org/about/com...
Compendium Partners
 Society for Healthcare Epidemiology
of America (SHEA)
 Infectious Disease Society of America
(IDSA)...
Compendium Endorsers
 American Organization of Nurse Executives
(AONE)
 Association for Respiratory Care (AARC)
 Infusi...
Compendium Supporters
 AARP
 Academy Health
 Agency for Healthcare
Research and Quality (AHRQ)
 American Academy of
Em...
Six Categories of HAIs
 Two focused on Specific Organisms
 Methicillin Resistant Staphylococcus
aureus (MRSA)
 Clostrid...
Six Categories of HAIs
 Four Device-and Procedure-Associated
 Central Line Associated Bloodstream
Infections (CLABSI)
 ...
SHEA / IDSA Compendium
 Compliments CDC guidelines
 Includes metrics and indicators of
success
 Updated guidance in are...
Patient Guides
 Developed by the SHEA Patient Safety
and Quality Improvement Committee in
collaboration with the Centers ...
Recommendation Format
 Purpose
 Rationale and Statements of Concern
 Strategies to Detect
 Strategies to Prevent
 Rec...
Strategies to Detect
 Surveillance Protocol and definitions
 Use consistent surveillance methods and
definitions to allo...
Strategies to Prevent
 Existing guidelines and
recommendations
 Infrastructure requirements
 Practical approaches
Recommendations for
Implementing Prevention and
Monitoring Strategies
 Basic Practices
 Special Approaches
 If rates ar...
Performance Measures
 Internal Reporting
 Process Measures
 Outcome Measures
 External reporting
 State and federal r...
Strength of Recommendation
and Quality of Evidence
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
 Rationale and Statements of Concern
 Increased le...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
 Strategies to Detect
 Use NHSN Criteria
 Bloodst...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
 Strategies to Prevent
 Existing Guidelines & Reco...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
 Strategies to Prevent
 Practical Implementation
...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
 Basic practices for prevention and monitoring
 Be...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
 Basic practices for prevention and monitoring
 Af...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
 Basic practices for prevention and
monitoring
 Af...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
 Basic practices for prevention and
monitoring
 Pe...
Edwards JR et.al. National Healthcare Safety Network (NHSN) Report, data summary for 2006-2007,
issued November 2008.. Am ...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)- Special Approaches
 Lack of effective control desp...
Prevention of Central Line
Associated Bloodstream Infections
(CLABSI)
Approaches NOT recommended
 Antimicrobial prophylax...
Updating the Compendium
 SHEA/APIC/IDSA Standards and
Practice Guidelines Committee will
determine the need for revisions...
HAI Compendium
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HAI Compendium

  1. 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. 2.  Infection Control and Hospital Epidemiology; October 2008, Vol. 29. Supplement 1  http://www.shea- online.org/about/compendium.cfm
  3. 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. 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. 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. 6. Six Categories of HAIs  Two focused on Specific Organisms  Methicillin Resistant Staphylococcus aureus (MRSA)  Clostridium difficile infection (CDI)
  7. 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. 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. 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. 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. 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. 12. Strategies to Prevent  Existing guidelines and recommendations  Infrastructure requirements  Practical approaches
  13. 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. 14. Performance Measures  Internal Reporting  Process Measures  Outcome Measures  External reporting  State and federal requirements  External quality initiatives
  15. 15. Strength of Recommendation and Quality of Evidence
  16. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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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