Patient Safety Checklists Help Michigan Hospitals ROI

Published on American Medical News Website

Michigan hospitals that implemented checklists to prevent central line-associated bloodstream infections in their intensive care units saw an average tenfold return on their investment in patient safety, said a study published in the September/October issue of the American Journal of Medical Quality(www.ncbi.nlm.nih.gov/pubmed/21856956).

Each catheter-related bloodstream infection costs a Michigan hospital $36,500 to treat, on average, but implementing the checklist program costs only about $3,375 per infection avoided. More than 100 Michigan ICUs were able to cut bloodstream infections by an average of two-thirds, with many hospitals eliminating the infections entirely. On average, each hospital saved about $1.1 million a year by implementing the patient safety program, the study said. The patient safety "bundle" now being spread to hospitals nationwide costs each hospital an average of $161,000 to put into place, mostly for staff time.

For more information on reducing Hospital Acquired Infections please visit Patient Safety & Quality Healthcare 

Advanceweb Highlights Role of Infection Preventionist

From Advanceweb.com
By Donna Williams

Today's battle with HAIs has become more difficult to fight. MRSA,VRSA, VISA are ganging up on us. We need reinforcements. A new title in infection control has emerged in response to the increase in HAIs. This role has taken the infection control department to a higher level.
The infection preventionist (IP) is an expert in educating the patient and hospital staff on patient safety measures related to reducing hospital acquired infections.

The infection preventionist will develop and implement practices for safety by using surveillance techniques along with other activities to help improve patient care in the fight against HAIs. As with any team approach, the IP will follow up with the healthcare team and the patients to effectively monitor compliance.

The Association for Professional Infection Control and Epidemiology (APIC) has a new campaign titled, "Infection Prevention and You." The idea is to incorporate a team approach using evidence-based practice for healthcare workers and patients in the fight against hospital acquired infections. Patients may receive educational materials to familiarize themselves about what they can do to prevent infections. The information contains tips on helping the patient to effectively communicate with their healthcare team.

To read full blog post please visit AdvanceWeb

Mercy Hospital Win Prestigious Award from HHS

Mercy Hospital, part of Allina Hospitals & Clinics, is only one of four hospitals in the U.S. to be awarded an Outstanding Leadership Award from the U.S. Department of Health and Human Services (HHS) for achievements in eliminating two types of hospital acquired infections (HAI).Mercy is the only hospital in Minnesota to earn an Outstanding Leadership Award, the highest level, for eliminating central-line associated blood-stream infections (CLABSI) and ventilator associated pneumonia (VAP). Out of 2,400 patients who receive care at Mercy’s intensive care unit every year, there have been no cases of CLABSI for nearly three years and only one case of VAP per year.

“This is an impressive accomplishment that few hospitals have earned because of the difficulty and complexity involved in eliminating these infections,” said Mary Jo Morrison, Allina’s vice-president of performance improvement. “It’s also important because these are key quality measures and CLABSI is also one of the proposed measures for accountable care organizations.”

Hospital Acquired Infections National Priority

Hospital acquired infections affect about one in twenty hospitalized patients and HHS has set a goal of reducing them by 40 percent by the end of 2013, which could save more than 60,000 lives. Eliminating hospital acquired infections is also a focus of the federal Affordable Care Act. The law includes the Hospital Value Based Purchasing Program which will reward larger payments to high performing hospitals. HHS awarded a total of 37 hospitals for making progress in eliminating HAI.

“This award reflects the leadership support and collaboration of our team to continually seek ways to eliminate all healthcare-associated infections, and to ensure every patient receives safe, reliable, yet cost effective care,” said Michelle Farber, board certified infection preventionist at Mercy Hospital.

Eliminating CLABSI at Mercy Hospital Reduced Expenses by More Than $ 400,000

The Center for Disease Control and Prevention reports that a 58 percent reduction of CLABSI in US ICUs saved $414 million in extra costs from 2001-2009. Eliminating CLABSI at Mercy Hospital reduced medical expenses by an estimated $424,000 and resulted in 96 fewer days in the ICU for patients between 2007 and 2010. Preventing VAP saves about $18,000 per patient, according to the 2008 Advisory Board.

The effort to eliminate VAP and CLABSI at Mercy began in 2003 with initiatives that include:

    New infection prevention protocol. Mercy was one of the first hospitals in 2009 to implement a protocol to bathe ICU patients daily with the antiseptic Chlorhexidine Gluconate. Scientific research* has since proven the effectiveness of this practice in several multicenter trials and is evolving as a best practice among other hospitals in the nation.

    Early removal of catheter or ventilator. Protocols and order sets allow the ICU staff to wean patients from ventilators and to remove catheters as early as possible. Mercy has shared this early extubation protocol with hospitals across the U.S. and England.

    Clinical Action Teams. CAT teams focus on one area or opportunity. Teams review literature, implement evidence-based improvements and then hard-wire practices into work-flows. For example, a “Scrub the Hub” campaign highlighted the need to use friction with an alcohol pad for 15 seconds before accessing a port.

*Daily chlorohexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line-associated bloodstream infections. Dixon JM, et al. Am J Infect Control 2010; 38:817-21.

About Allina Hospitals & Clinics

Allina Hospitals & Clinics is a not-for-profit system of hospitals, clinics and other health care services, providing care throughout Minnesota and western Wisconsin. Allina owns and operates 11 hospitals, more than 90 clinics and specialty care centers, and specialty medical services that provide hospice care, oxygen and home medical equipment, pharmacies, and emergency medical transportation services. Allina Hospitals & Clinics and the latest health information can be found online at allina.com.

Atlanta Newspaper Covers on Hospital Acquired Infection Reporting in Georgia

By Carrie Teegardin

The Atlanta Journal-Constitution

In twenty eight states, hospitals are required by law to make a public report on at least some of the infections patients pick up while under the hospital's care. Georgia is not one of those states, and patient advocates say that makes it difficult for consumers to make informed choices about where to go for health care.

"This should be something the state does for its consumers," said Holly Lang, director of the Hospital Accountability Project at Georgia Watch, a statewide consumer organization.If restaurants must post their inspection scores on their walls, then hospitals should have to disclose rates of potentially deadly infections within their facilities, Lang said. That would help patients choose a hospital, she said, while also pressuring hospitals to improve patient safety.


Legislation to require reporting on infections at hospitals has been proposed in Georgia but not passed, said Pam Keene, a spokeswoman for the Georgia Department of Community Health."I think hospitals felt very defensive about releasing information because they felt it would be bad for their marketing," said state Rep. Pat Gardner, D-Atlanta.But Gardner said that needs to change. "This is the age of consumer directed health care and if we want consumers to take a more active role in their health care, they need access to all kinds of information that is not currently available to them," she said.

Kevin Bloye, spokesman for the Georgia Hospital Association, said the state's hospitals are cautious about public reporting of infection and quality data because hospitals are still working to develop accurate systems for collecting such information that allows for fair comparisons. "More transparency is what the public wants and we're responsive to that," Bloye said. "But the key is making sure what we report is right and fair to each of the stakeholders involved."

http://www.ajc.com/news/georgians-kept-in-dark-975123.html?printArticle=y

Hospital Aquired Infections at Houston Hospitals Reported In New Study

As reported by Yang Wang/ Houston Chronicle

The most common patient safety issue among older patients in the Houston area is systemic vascular infections, a problem often caused by unsanitary or improper procedures during their hospital stay, a new study of Medicare claims shows. Among forty six hospitals within a fifty mile radius of the city of Houston, 50% reported vascular infections in Medicare patients through catheters. A total of 472 "hospital-acquired conditions" were reported from the 234,200 Medicare discharges from October 2008 through June 2010. That's two incidents per 1,000 Medicare discharges in Houston.

Allowing the public to see information about mishaps and errors that occur during a patient's hospital stay has been a contentious issue for hospital personnel, who believe the public could misread it. To date, there's no universal ranking system for the public to determine the safety of the nation's hospitals.The reports released this month by the Centers for Medicare and Medicaid Services is the first to look strictly at how many times bedsores, surgical errors and falls and trauma, for example, occur among Medicare patients. 

To read the full article please visit:  http://www.chron.com/disp/story.mpl/metropolitan/7535533.html

For more reporting on hospital acquired infections please visit Patient Safety & Quality Healthcare

CDC issues guidance on preventing bloodstream infections

 Hospital Acquired Infections Still A Major Patient Safety Problem

 As reported in American Medical News
By Kevin B. O'Reilly



Recently health officials  updated their recommendations on preventing catheter-related bloodstream infections in light of successful efforts that have helped reduce  the national rate of central-line infections in intensive care units by fifty eight percent between 2001 and 2009. The new guidelines were released in April by the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee 

Among the recommended infection-prevention measures, the new guidance calls for:

• Educating health professionals about when to use catheters, how to insert them and what infection-control measures to take when doing so.
• Designating trained, competent professionals to insert and maintain peripheral and central vascular catheters.
• Avoiding the femoral vein for central venous access in adult patients.
• Using a fistula instead of a central venous catheter in dialysis patients with chronic renal failure.
• Promptly removing any intravascular catheter that is no longer essential.
• Cleaning patients' skin with a chlorhexidine preparation with alcohol before inserting a central venous catheter.

 To read the full article please visit: http://www.ama-assn.org/amednews/2011/04/18/prsb0419.htm?utm_source=twitterfeed&utm_medium=twitter


For more information on Patient Safety please visit www.psqh.com

UV Radiation Helps Control Hospital Room Infections

Previously published in Patient Safety & Quality Healthcare website

Results of an 8-month hospital study, "Room Decontamination with UV Radiation," were published in the October 2010 issue of "Infection Control and Hospital Epidemiology." The study evaluated the ability of an automated UV device, Tru-D, to decontaminate patient rooms contaminated with MRSA, VRE, C. difficile and a MDR strain of Acinetobacter baumannii.The research team of William A. Rutala, PhD, MPH, Maria F. Gergen, MT (ASCP), and David J. Weber, MD, MPH, conducted the study at University of North Carolina Health Care from January 21 through September 21, 2009.

Epidemiologic studies show that patients hospitalized in rooms occupied previously by infected individuals experience a significantly higher rate of acquiring infectious organisms from environmental surfaces. Trials using fluorescent markers reveal that only 48% of environmental surfaces are actually disinfected during terminal cleaning.These studies identify problems associated with manual disinfection and provide substantial opportunities to improve the patient environment, while inspiring the development of decontamination devices like the automated Tru-D (Total Room Ultraviolet Disinfection).

During phase 1 of the North Carolina trial, MRSA, VRE, Acinetobacter baumannii, and Clostridium difficile samples were placed behind objects and within line-of-sight of the UV-C device. UV-C reduced vegetative bacteria counts by more than 99.9% within 15 minutes. C. difficile spore reduction was 99.8% within 50 minutes. For phase 2, isolation rooms for MRSA or VRE infected patients were sampled. After 15 minutes of UV-C exposure, researchers found a significant decrease in total CFUs (384 vs. 19), in positive MRSA samples (81 vs. 2), and in MRSA counts per plate (37 vs. 2). Similar reductions were recorded for VRE.

Meaningful reduction (3.3-3.9 log10) occurred when contaminants were shadowed from direct exposure (e.g., back of the handrails).

The team concluded that the environment-friendly UV-C device is effective in significantly reducing pathogens on all environmental surfaces, both line of sight and shadowed.

Results of published Tru-D studies should not be interpreted or applied to similar, second-tier products. Tru-D is ETL listed in conformance to UL STD 61010-1.

Call Jack Treas at 800-774-5799, or go to http://www.lumalier.com for additional data and a copy of the study, and to view a video clip of Tru-D recently featured on CBS Sunday Morning.

To read more about reducing Hospital Infections please visit Patient Safety website

Ventilator-Associated Pneumonia- Its the Little Things that Count

By Nancy Landor, RN, MS, CPHQ; and Patty Montone Charvat

Making sure that the head of a patient bed is elevated 30% is just one of the important elements for preventing ventilator-associated pneumonia (VAP) in critical care units. It may sound simple to do, but many hospitals still believe that you can judge the elevation strictly by sight, which is not necessarily the case. In fact, at one hospital, when they measured, only 15% of beds were elevated to the appropriate angle.

However, there are some very low or no cost, easy ways to ensure that the patient bed is elevated 30%. For example, one nurse at Stony Brook University Medical Center cut a piece of cardboard in the shape of a slice of pizza, which is now used to measure the elevation of the patient bed. Based on input from staff at Beth Israel Medical Center, a red stripe was placed on each bed by the Engineering Department to ensure accuracy in the elevation of the patient bed.

These and other practical solutions are having a significant impact on preventing and reducing VAP in hospitals. This is merely a sample of the solutions and best practices that were shared by 50 New York hospitals through a statewide collaborative focused on VAP prevention conducted by the Healthcare Association of New York State (HANYS).

As part of its extensive quality and research agenda, HANYS and its member hospitals have been focusing on the prevention of hospital-acquired infections, including VAP. Grant funding from the New York State Department of Health Division of Epidemiology-Hospital Acquired Infection (HAI) Program helped to support a quality improvement collaborative, led by HANYS, called the VAP prevention (VAPP) program.
"After conducting an assessment of our members, we chose VAP because it is a leading cause of death—due to healthcare acquired infection (HAI)—in critical care, and experiences by other national initiatives demonstrated that focused efforts on the VAP bundles could prevent a pneumonia infection, which in turn improves patient care, decreases mortality rates, and lower costs," said Nancy Landor, senior director of HANYS Strategic Quality Initiatives.

The Collaborative used the Institute for Healthcare Improvement's (IHI's) VAP bundle elements, plus additional elements from the IHI's Critical Care IMPACT Program as the core of improvement activities.

The initiative relied on the hospitals' infection control practitioners for leadership, education, and data. At the end of the first quarter of 2008, the advisory committee set a stretch goal: achieving an overall VAP rate of less than one event per 1,000 ventilator days in the last quarter of 2008.

"Like many stretch goals, it seemed only possible, even only somewhat doable, but we felt it was important for promoting real change," said Landor.

To read the complete article please visit Patient Safety & Quality Healthcare