1. Hospital Acquired Infections & Quality Improvement Texas Rural Health Forum Conference, Austin, Texas November 10, 2010 Terri Conner, Vice President, TCQPS at THA, Austin, TX Nicolas Abella, Corporate Dir Med Surg & Critical Care Brownwood Regional Medical Center, Brownwood, TX Patti R Bull, Infection Prevention Coordinator Hendrick Medical Center, Abilene, TX Cheryl Herbert, Executive Director Good Shepherd Medical Center, Longview, Tx Katherine McDuffie, Education Coordinator Fort Duncan Regional Medical Center, Eagle Pass, Texas

2. Agenda  Discuss collaborative initiatives that aim to reduce or eliminate HAIs –central-line associated bloodstream and catheter- associated urinary tract infections  Discuss the importance of these initiatives  Roundtable Discussion about rural hospital involvement 2

3. Healthcare-associated infections  In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections: –32 percent of all healthcare-associated infection are urinary tract infections –22 percent are surgical site infections –15 percent are pneumonia (lung infections) –14 percent are bloodstream infections 3

4. TCQPS/THA HAI Initiatives  On the CUSP: Stop BSI –Over 30 states are participating in this initiative –Goal is to reduce CLABSI rates to 1 per 1000 line days  On the CUSP: Stop UTI –First cohort in Texas begins initiative in January 2011 –Goal is to reduce CAUTI rates by 25%  Possible future initiative: On the CUSP: ESRD –Reduce infection in dialysis units 4

5. CUSP & CLABSI Interventions Project Goals: Two Objectives Objective #1:Create a Culture of Safety: CUSP Steps 1.Educate on the science of safety 2.Identify defects 3.Assign executive to adopt unit 4.Learn from defects 5.Implement teamwork & communication tools Objective #2:Eliminate CLABSI Steps 1.Educate staff 2.Create a central line cart 3.Remove unnecessary lines 4.Implement a central line checklist 5.Empower staff to stop procedure

6. Why the Initiatives are Important  External Environment –Driven by the belief that hospital care can and should be safer, more efficient and cheaper:  Key point of HHS Secretary Kathleen Sebelius’ initiative to reduce hospital-acquired infections (HAIs)  CMS not reimbursing for HAIs  Public reporting in 2011

7. CLABSI Initiative in Particular  Preventing Harm –The CDC estimates that 250,000 patients die per year due to CLABSI  Medical costs between $5,700 and $23,000 per infection –CLABSIs are not inevitable – we can get to ZERO  These reductions have been achieved using the processes at the core of On the CUSP: Stop BSI

8. Key Points and Issues – Roundtable Discussion  Culture of Safety –First focus on patient safety –All initiatives can be implemented easier when the culture enables the effort  Nationally Recognized Standards –Evidence Based Care –Literature by physicians 8

9. Discussion Continued  Implementation –Resources  Don’t reinvent the wheel – public domain  Non traditional roles –Commitment –Barriers  Conversations  Data 9

10. Texas Center for Quality & Patient Safety  We encourage your input –What initiatives are you currently working on? –What initiatives do you think you should be working on?  Problem areas – opportunity for improvement  Costly conditions Terri Conner at tconner@tha.org or 512/465-1021tconner@tha.org Maria Rascati at mrascati@tha.org or 512/465-1003mrascati@tha.org 10