Transcript Slide 1

NQF-Endorsed®
Safe Practices for Better Healthcare
Safe Practice 24
Multidrug-Resistant Organism Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
1
Slide Deck Overview
Slide Set Includes:
 Section 1:
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Section 2:
Section 3:
Section 4:
Section 5:
Section 6:
© 2010 TMIT
© 2006 HCC, Inc. CD000000-0000XX
NQF-Endorsed® Safe Practices for
Better Healthcare Overview
Harmonization Partners
The Problem
Practice Specifications
Example Implementation Approaches
Front-line Resources
2
NQF-Endorsed®
Safe Practices for Better Healthcare
Overview
Safe Practice 24
Multidrug-Resistant Organism Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
3
2010 NQF Safe Practices for Better
Healthcare: A Consensus Report
34 Safe Practices
• Criteria for Inclusion
• Specificity
• Benefit
• Evidence of Effectiveness
• Generalization
• Readiness
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Culture SP 1
2010 NQF Report
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Culture
Structures
and Systems
Culture Meas.,
FB., and Interv.
Team Training
and Skill Bldg.
Risk and Hazards
CHAPTER 2: Creating and Sustaining a Culture of
Safety (Separated into Practices]
 Culture of Safety Leadership Structures and Systems
 Culture Measurement, Feedback, and Intervention
 Teamwork Training and Skill Building
 Risks and Hazards
Consent
& Disclosure
Consent
and
Informed
Consent
Life-Sustaining
Treatment
Care of
Caregiver
Disclosure
Workforce
Nursing
Workforce
Direct
Caregivers
CHAPTER 4: Workforce
• Nursing Workforce
• Direct Caregivers
• ICU Care
ICU Care
Information Management and Continuity of Care
Patient
Care Info.
Read-Back
& Abbrev.
Labeling
Diag. Studies
Discharge
Systems
CHAPTER 3: Consent and Disclosure
• Informed Consent
• Life-Sustaining Treatment
• Disclosure
• Care of the Caregiver
CPOE
Medication Management
CHAPTER 5: Information Management and Continuity
of Care
 Patient Care Information
 Order Read-Back and Abbreviations
 Labeling Diagnostic Studies
 Discharge Systems
 Safe Adoption of Computerized Prescriber Order
Entry
CHAPTER 6: Medication Management
 Medication Reconciliation
 Pharmacist Leadership Structures and Systems
Med. Recon.
Pharmacist Leadership
Structures and Systems
Healthcare-Associated Infections
Influenza
Prevention
Hand Hygiene
Sx-Site Inf.
Prevention
VAP
Prevention
Central Line-Assoc.
BSI Prevention
MDRO
Prevention
UTI
Prevention
Condition- and Site-Specific Practices
Wrong-site
Sx Prevention
Contrast
Media Use
Organ
Donation
Press. Ulcer
Prevention
Glycemic
Control
VTE
Prevention
Falls
Prevention
Anticoag.
Therapy
Pediatric
Imaging
CHAPTER 7: Healthcare-Associated Infections
• Hand Hygiene
• Influenza Prevention
• Central Line-Associated Blood Stream Infection
Prevention
• Surgical-Site Infection Prevention
• Daily Care of the Ventilated Patient
• MDRO Prevention
• Catheter-Associated UTI Prevention
CHAPTER 8: Condition- and Site-Specific Practices
• Wrong-Site, Wrong-Procedure, Wrong-Person
Surgery Prevention
• Pressure Ulcer Prevention
• VTE Prevention
• Anticoagulation Therapy
• Contrast Media-Induced Renal Failure Prevention
• Organ Donation
• Glycemic Control
• Falls Prevention
• Pediatric Imaging
Harmonization Partners
Safe Practice 24
Multidrug-Resistant Organism Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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Harmonization – The Quality Choir
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The Patient – Our Conductor
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The Objective
Multidrug-Resistant Organism Prevention
 Prevent healthcare-associated multidrug-resistant
organism (MDRO) infections, including methicillinresistant Staphylococcus aureus (S. aureus)
(MRSA), vancomycin-resistant enterococci (VRE),
and Clostridium difficile infections (CDIs)
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The Problem
Safe Practice 24
Multidrug-Resistant Organism Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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The Problem
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[http://query.nytimes.com/gst/fullpage.html?res=9E01E4D9173AF937A25757C0A96F9C8B63]
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[http://www.latimes.com/features/health/la-sci-badbugs17-2009feb17,0,5079716.story]
© 2010 TMIT
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[http://www.infectiousdiseasenews.com/article/59402.aspx]
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The Problem
Frequency
 MRSA accounts for more than 50% of hospitalacquired S. aureus infections
 82% of hospitals have not seen CDI rates
decrease in the past 3 years
 Doubling of hospital discharges with CDIs from
2001 to 2005
 Increase to more than 300,000 CDI cases in 2005
[NNIS, Am J Infect Control 2004 Dec;32(8):470-85; Jarvis, Am J Infect Control 2009 May;37(4):263-70; Carrico, Guide to the
Elimination of Clostridium difficile in Healthcare Settings, 2008]
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The Problem
Severity
 More than 5,000 deaths each year are
attributable to MRSA
 Attributable mortality rate of 6.9% at 30 days
and 16.7% at 1 year
[Institute for Healthcare Improvement, 5 Million Lives Campaign, 2008; Levinson, Adverse events in hospitals: state reporting
systems, 2008; Loo, N Engl J Med 2005 Dec 8;353(23):2442-9; Muto, Infect Control Hosp Epidemiol 2005 Mar;26(3):273-80;
Pépin, Clin Infect Dis 2005 Nov 1;41(9):1254-60]
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The Problem
Preventability
 40% reduction in MDROs by implementing a
checklist for hospital interventions
 A notification system should be established in
a timely manner
 The decrease in MDROs will also lead to a
decline in other infections
[Siegel, Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006; Siegel, Guideline for isolation
precautions: preventing transmission of infectious agents in healthcare settings, 2007; Abbett, Infect Control Hosp
Epidemiol 2009 Nov; 30(11):1062-9; Dubberke, Infect Control Hosp Epidemiol 2009 Jun;30(6):518-25; O’Dowd, BMJ 2009 Jun
26;338:b2580]
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The Problem
Cost Impact
 Additional cost of $39K per case in patients with
a MRSA surgical-site infection
 Mortality rates were 13% higher in patients with
MRSA infection
 Hospital costs due to CDI range from $6.4K to
$9.1K in 2007 dollars
[Engemann, Clin Infect Dis 2003 Mar 1;36(5):592-8; Scott, The direct medical costs of healthcare-associated infections in
US hospitals and the benefits of prevention, 2009]
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Practice Specifications
Safe Practice 24
Multidrug-Resistant Organism Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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Additional Specifications
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Safe Practice Statement
Multidrug-Resistant Organism Prevention
 Implement a systematic multidrug-resistant
organism (MDRO) eradication program built
upon the fundamental elements of infection
control, an evidence-based approach,
assurance of the hospital staff and independent
practitioner readiness, and a re-engineered
identification and care process for those
patients with or at risk for MDRO infections
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Additional Specifications
 The organization’s leadership has assigned
responsibility of the development, testing, and
implementation of an MDRO prevention
program
 Conduct a risk assessment for MDRO
acquisition and transmission
 Educate staff and licensed independent
practitioners about MDROs, including risk
factors, routes of transmission, outcomes
associated with infection, prevention measures,
and local epidemiology
[Siegel, Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006; Calfee, Infect Control Hosp Epidemiol. 2008
Oct;29 Suppl 1:S62-80; Dubberke, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S81-92; Joint Commission Resources,
National Patient Safety Goal NPSG.07.03.01, 2010; Institute for Healthcare Improvement, Infection Prevention, IHI Improvement
Map, 2009; Seto, J Hosp Infect 1995 Jun;30 Suppl:241-7; TMIT, MRSA: For the Birds, or Pandemic Potential?, 2008]
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Additional Specifications
 Educate patients colonized with MRSA and their
families about healthcare-associated infections
and infection prevention strategies
 Implement a surveillance program for MDROs
based on risk assessment
 Measure and monitor MDRO prevention
processes and outcomes
 Provide MDRO surveillance data, prevention
processes, and outcome measures to key
stakeholders
[Lewis, J Hosp Infect 1999 Sep;43(1):19-23; NHSN, Multidrug-resistant Organism and Clostridium difficile-Associated
Disease Module, 2009 ; Calfee, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S62-80]
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Additional Specifications
 Implement a system to provide immediate
notification about newly diagnosed MDROcolonized or -infected patients
 Implement an alert system that identifies
readmitted or transferred MRSA-colonized or
-infected patients
 Promote compliance with hand hygiene
recommendations
 Use contact precautions for MDRO-colonized or infected patients
 Ensure cleaning and disinfection of equipment
and environment
[Boyce, Infect Control Hosp Epidemiol 2009 Jun;30(6):515-7; Johnson, Med J Aust 2005 Nov 21;183(10):509-14; Centers for
Disease Control and Prevention, Preventing Transmission of Infectious Agents in Healthcare Settings, 2007; D’Agata, Clin
Infect Dis 2009 Feb 1;48(3):274-84; Institute for Healthcare Improvement, Standard Precautions: IHI Improvement Map, 2009;
Lederer, Jt Comm J Qual Patient Saf 2009 Apr;35(4):180-5; Salgado, Am J Infect Control 2009 Feb 23]
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Example Implementation
Approaches
Safe Practice 24
Multidrug-Resistant Organism Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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Example Implementation Approaches
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© 2006 HCC, Inc. CD000000-0000XX
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Example Implementation Approaches
 Place patients with MDRO on contact
precautions to reduce patient-to-patient spread
of the organism within the hospital
 Ensure cleaning and disinfection of equipment
and the environment
 Implement an MRSA active surveillance program
 Initiate an antimicrobial stewardship program
[Calfee, Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S62-80; Agency for Healthcare Research and Quality, National
Healthcare Quality Report 2008, 2009; Institute for Healthcare Improvement, Antibiotic Stewardship, IHI Improvement Map,
2009; Weber, What Every Health Care Executive Should Know: The Cost of Antibiotic Resistance, 2009]
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Example Implementation Approaches
Strategies of Progressive Organizations
 Readiness of hospital staff and independent
practitioners:
 For program success, there must be a culture
change
 Accountability of leaders and their staff is
absolutely necessary in order to decrease
MDRO infections and prevent needless
morbidity and mortality
 Hospital leadership performs tracers
[Humphreys, Clin Microbiol Infect 2009 Feb;15(2):120-4; Mears, J Hosp Infect 2009 Apr;71(4):307-13]
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Front-line Resources
Safe Practice 24
Multidrug-Resistant Organism Prevention
Chapter 7:
Improving Patient Safety Through the
Prevention of Healthcare-Associated Infections
© 2010 TMIT
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[http://www.shea-online.org/about/compendium.cfm; http://www.ncbi.nlm.nih.gov/pubmed/18840091]
© 2010 TMIT
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[http://www.ncbi.nlm.nih.gov/pubmed/18840090]
© 2010 TMIT
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[http://www.cdc.gov/media/pressrel/2010/s100202.htm]
© 2010 TMIT
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[http://www.shea-online.org/Assets/files/patient%20guides/NNL_C-Diff.pdf]
© 2010 TMIT
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[http://www.shea-online.org/Assets/files/patient%20guides/NNL_MRSA.pdf]
© 2010 TMIT
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[http://www.jointcommission.org/PatientSafety/SpeakUp/]
© 2010 TMIT
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Poster available in Spanish
TMIT National Webinar Series
Healthcare-Associated Infection and You:
Cleaner, Safer Care (Safe Practices 19-25)
 Kathy Warye – Topic: Perspective on the
Development of the Implementation Examples of the
NQF Safe Practices
 Peter Angood, MD – Topic: HAI National Attention
and Harmonization
 David Classen, MD – Topic: HAI Compendium
Harmonization with the Safe Practices
 Julianne Morath, RN – Topic: Implementation
 Jennifer Dingman – Topic: Call to Action
 Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4932
(May 14, 2009)
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TMIT National Webinar Series
MRSA: For the Birds, or Pandemic Potential?
(Safe Practice 22)
 Cheryl Ann Creen, RN, MSN – MRSA Prevention
Coordinator, VA Pittsburgh Healthcare
 Candace Cunningham, RN – MRSA Prevention
Coordinator, Acute Care, VA Pittsburgh Healthcare
System
 Jan Englebright, PhD, RN – Chief Nursing Officer, HCA
 Jason Hickok, MBA, RN – Director, Critical Care &
Infection Prevention, Clinical Services Group, HCA
 Jonathan Perlin, MD – Chief Medical Officer, HCA
 Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4877
(April 8, 2008)
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