BSIVAP APIC conference Austin 3-2012Posa [Compatibility Mode]

107 Pages·2012·3.67 MB·English

Power of One:
Strategies
for Preventing CLA-BSI’s &
VAP on Your Watch
Target Zero
Pat Posa RN, BSN, MSA
System Performance Improvement Leader
St. Joseph Mercy Health System
Ann Arbor, MI
[email protected]
Disclosures
•Consultant-Michigan Hospital
Association Keystone Center
•Consultant-Missouri Center for
Patient Safety
••CCoonnttrraacctteedd ccoonnssuullttaanntt ffoorr
Advancing Nursing, LLC
– Consulting services:
• Edward Lifesciences
• Sage Products
Session Objectives
• Identify risk factors for the development of central line
associated blood stream infections and ventilator
associated pneumonia
• Define key care practices based on the evidence that can
rreedduuccee aanndd ssuussttaaiinn zzeerroo BBSSII’’ss
• Define key care practices based on the evidence that can
reduce and sustain zero VAP’s
• Discuss strategies to work on a safety culture as care
practices are changed.
Infection epidemic carves deadly path
Poor hygiene, overwhelmed workers contribute to thousands of
deaths
July 21, 2002| By Michael J. Berens, Tribune staff reporter.
“A hidden epidemic of life-threatening infections is contaminating America's
hospitals, needlessly killing tens of thousands of patients each year. These
infections often are characterized by the health-care industry as random and
inevitable byproducts of lifesaving care. But a Tribune investigation found
that in 2000, nearly three-quarters of the deadly infections--or about 75,000—
were preventable, the result of unsanitary facilities, germ-laden instruments,
unwashed hands and other lapses…”
Why HAI’s?
• 2.5 million HAI’s year/USA
• Everyday, 247 people die in the USA as a
result of a HAI
•• 55--1100%% ooff aallll ppaattiieennttss aaddmmiitttteedd ttoo UUSS hhoossppiittaall
annually contract HAI’s (1 of every 10-20
patients)
• 6th leading cause of death in the US
• Higher nurse staffing results in lower HAI’s*
*Hugonnet S et al CCM 2007;35:76-81
*PrWonHoOv o20s0t 5PJ et al JAMA 1999;281:1310-1317
*NeYeodkoleem DaS,n e tJ a el. tI nafle.c Nt C Eonntgroll oHfo Mspe Edp i2de0m0i2o;l3 240068:1;2791:S51-2-S21.
1722
It is Time to Change!!
• 44,00 to 98,000 preventable death in hospitals related to
medical errors annually (IOM report, 1999)
• 92,888 deaths directly attributable to safety indicators
bbeettwweeeenn 22000055--22000077 ((HHeeaalltthhGGrraaddeess 22000099))
– post-op infections, failure to rescue & pressure ulcers
• National Patient Safety Goals include prevention of HAI’s
• Lack of reimbursement for preventable injury
Yokoe DS, et al. Infect Control Hosp Epidemiol 2008;29:S12-S21.
Needleman J et al. N Engl of Med 2002;346:1715-1722
It is Time to Change!!
• $50 billion in total costs for preventable injury
• 2011 mandatory federal reporting of CLA-BSI’s
•• 22001133--lloowweesstt ppeerrcceenntt iimmpprroovveemmeenntt//ttoottaall
Medicare cut
• HHS goal to reduce HAI’s by 40% in 3 years
(1 billion to assist in achieving goal)
Yokoe DS, et al. Infect Control Hosp Epidemiol 2008;29:S12-S21.
Needleman J et al. N Engl of Med 2002;346:1715-1722
http://www.hhs.gov/news/press/2011pres/06/20110622a.html
http://content.healthaffairs.org/content/30/4/723.abstract
How Big of a Problem are Health Care-Associated
Infections (HAIs) in U.S. Hospitals?
Total HAI’s / year = 1.7 million; 98,987 deaths
263,810
274,098 TOTAL
Other 133,368
-967 HRN BSI
22%
11%
-21 WBN
SSI
--2288,,772255 NNoonn--nneewwbboorrnn IICCUU
20%
= SSI
244,385
UTI
PNEU
36%
11%
424,060
129,519
HRN=High Risk Newborn, WBN=Well Baby Nursery, ICU=Intensive Care Unit,
SSI=Surgical Site Infection, BSI=Bloodstream Infection, UTI=Urinary Tract Infection, Pneu=Pneumonia
Klevens, et al. Pub Health Rep2007;122:160-6
Value Sets Platform for Performance Improvement
The Vision of Health Care in the U.S. 2012 -
• Fragmented
• Fee-for-service
Cost Volume-
driven
hheeaalltthhccaarree
•• CCoonnnneecctteedd
• Bundled
• Accountable
VALUE-
driven
healthcare
Quality
The Journey Towards Value-Based Purchasing Begins
:
• Payment reforms for inpatient hospital services in 2008
– …ensure that Medicare no longer pays for the additional costs
of certain preventable conditions (including certain infections)
acquired in the hospital…
1) Serious preventable events: Object left in during surgery; air
eemmbboolliissmm;; DDeelliivveerriinngg AABBOO--iinnccoommppaattiibbllee bblloooodd oorr bblloooodd pprroodduuccttss
2) catheter-associated urinary tract infections (CAUTIs)
3) pressure ulcers
4) Vascular catheter associated infection
5) Mediastinitis after CABG surgery
6) Patient falls – refining for FY09
Coming attractions?: VAP – Not yet, S. aureus BSI – Yes but
limited to MRSA LabID, MRSA- No, CDI – Yes, LabID