Healthcare Associated Infections (HAI Project) CLABSI’s (Insert your hospital name In Partnership with IPRO Date

CMS  Leads a national healthcare quality improvement program, implemented locally by an independent network of QIOs in each state and territory. IPRO  The federally funded Medicare Quality Improvement Organization (QIO) for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS).  IPRO provides a full spectrum of healthcare assessment and improvement services that foster the efficient use of resources and enhance healthcare quality to achieve better patient outcomes. 2

As the QIO for New York State, IPRO works to achieve the goals of the national QIO program by  Convening communities of providers, practitioners and patients across the state to:  Share knowledge,  Spread best practices,  Achieve rapid, wide-scale improvements in patient care. 3

Improving Individual Patient Care Reducing Healthcare Associated Infections

HAI Overview 5 APIC Statement on the Cost of Hospital Associated Infections 2 million patients per year ~90,000 deaths $4.5-$5.7 billion per year in patient care costs

HAI Overview 6 HAIs rank in the top 10 leading causes of death in the US * * Klevens RM, Edwards JR, Richards CL, et al. Estimating healthcare-associated infections and deaths in U.S. hospitals, Public Health Rep. 2007; 122:

Financial Imact of HAI 7 HAIs harm the bottom line Hospital-acquired conditions lead to loss of revenue and as a part of value based purchasing, medical errors will NOT be reimbursed. Hospital Profits

Reporting HAI’s 8

Improving Individual Patient Care Central Line Associated Bloodstream Infections CLABSI’s

Financial Impact 10 Infection Type2005 Mean Costs CLABSI$18,432* *Perenchvich EN, et al.Infect Control Hosp EPID Oct **APIC Cost of Hospital-Associated Infections Model ***TMIT Cost of HAI Calculator

CLABSI Background 11 Bloodstream infections (BSIs) are a major cause of healthcare-associated morbidity and mortality Up to 35% attributable mortality BSI leads to excess hospital length of stay of 24 days Central Line (CL) use is a major risk factor for BSI More than 250,000 central line-associated BSIs (CLABSIs) in US yearly Rates of CLABSI appear to vary by type of catheter

CLABSI Overview 12 CLABSIs are Serious but Preventable Infections Michigan Keystone Project was able to decrease CLABSIs by 66% in 103 ICUs in Michigan by using basic interventions, such as hand hygiene, chlorhexidine, and avoidance of a femoral site BSI “outbreaks” have been associated with failure to adequately decontaminate catheter hubs or failure to change them at appropriate intervals Use of Antimicrobial Catheters - 2 types with most supporting evidence: Minocycline-Rifampin & Chlorhexidine–Silver Sulfadiazine Ensure utilization of Central Line Insertion (CLIP) bundle: Chlorhexidine for skin antisepsis Maximal sterile barrier precautions (e.g., mask, cap [i.e., similar to those worn in the O.R.], gown, sterile gloves, and large sterile drape) Hand hygiene MMWR - Early Release/vol.60; March 1, Central Line Associated Blood Stream Infections, United States, , 2009

CLABSI Overview 13

CLABSI – Project Goals 14 MeasureProject Target CLABSI relative improvement 50% CLABSI SIR≤ 1.0 CLABSI incident rate≤ 1.0/1000 central line days CLIP Adherence Rate100%

Central Line Insertion Practices (CLIP) 15 CLIP - Required fields for data entry into NHSN (Double Click on the ICON to open the form) For the unit chosen to participate in the HAI project, a CLIP Form must be completed for every line inserted in that unit.

Sources for CLABSI Guidelines

Sources of CLABSI Guidelines 17 Guidelines for the Prevention of Intravascular Catheter-related Infections (O’Grady, et al) as published in the May 2011 edition of the American Journal of Infection Control Center for Disease Control and Prevention (CDC), Guidelines for the Prevention of Intravascular Catheter Related Infections, 2011

What do we do here at (hospital name) ?

Our current central-line policy is as follows: 19 Outline your central-line policy and clearly state what is expected. Who can insert a line? Is an assistant required? Is a check-list required for each insertion attempt? If there is a beach in technique, are personnel empowered to speak-up?

Our current central-line procedure is as follows 20 Outline your insertion and maintenance procedure (checklists) and highlight areas in and out of compliance Review the insertion checklist Show data for compliance with items from the insertion checklist (handwashing, drapes, gowns, gloves, caps)

Our results are as follows 21 Outline your results and provide any graphs and data to demonstrate where you were when you began your CLABSI project and where you are now. Include any interventions which have contributed to improving care and/or modifying procedures. If available, use the IPRO HAI report to show your results Run NHSN reports for CLABSI’s and CLIP adherence. Share your findings with the staff.

Our Improvement Plan is as follows 22 Outline the next steps for your organization to improve or “hold the gains”. Has this project been spread to the entire organization? If not, do you have a target data to move the project house-wide? If no, consider setting a date. Consider implementing a PDSA to spread your success to another unit. We recommend spreading change slowly.

Template 1/13/2012 This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM

For more information Template 1/13/2012 IPRO Contacts Karline Roberts (518) Bill Gardiner (518) Crystal Isaacs (516) Chad Wagoner (518) Teré Dickson, MD (516) Hospital Contacts Fill in the names of your hospital contacts