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CHALLENGES FOR INFECTION PREVENTION IN THE 21ST CENTURY
William A. Rutala, PhD, MPH Director, Hospital Epidemiology, Occupational Health and Safety; Professor of Medicine and Director, Statewide Program for Infection Control and Epidemiology University of North Carolina at Chapel Hill and UNC Health Care, Chapel Hill, NC
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Disclosure This presentation reflects the techniques, approaches and opinions of the individual presenter. This Advanced Sterilization Products (“ASP”) sponsored presentation is not intended to be used as a training guide. Before using any medical device, review all relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device(s). I am compensated by and presenting on behalf of ASP, and must present information in accordance with applicable FDA requirements. The third party trademarks used herein are trademarks of their respective owners.
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DISCUSSION TOPICS Impact of healthcare-associated infections
Challenges in infection prevention
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HEALTHCARE-ASSOCIATED INFECTIONS: IMPACT IN UNITED STATES
1.7 million infections per year 98,987 deaths due to HAI Pneumonia 35,967 Bloodstream 30,665 Urinary tract 13,088 SSI 8,205 Other 11,062 6th leading cause of death (after heart disease, cancer, stroke, chronic lower respiratory diseases, and accidents)1 1 National Center for Health Statistics, 2004
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INCREMENTAL HOSPITAL DAYS DUE TO COMMON HAIs
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MORTALITY RATE OF COMMON HAIs
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COST ESTIMATES FOR HEALTHCARE-ASSOCIATED INFECTIONS (HAIs)
Cost per HAI US$ + SE Range Ventilator-associated pneumonia 25, ,132 8,682-31,316 Healthcare-associated bloodstream infections 23, ,184 6,908-37,260 Surgical site infections 10, ,249 2,527-29,367 Catheter-associated urinary tract infections Anderson DJ, et al. ICHE 2007;28: Costs based on literature review ; adjusted to US 1995 dollars
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PATHOGENS ASSOCIATED WITH HAIs*: NHSN, 2006-2007
HAI: CLA-BSI, CA-UTI, VAP, SSI Hidron AI, et al. ICHE 2008;29:
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FUTURE OF INFECTION CONTROL
Changing population of hospital patients Increased severity of illness Increased numbers of immunocompromised/older patients Shorter duration of hospitalization More and larger intensive care units Larger step-down units Growing frequency of antimicrobial-resistant and emerging pathogens Lack of compliance with hand hygiene and other infection preventive measures (e.g., endoscope)
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FUTURE OF INFECTION CONTROL
Limited infection prevention resources Implementation of guidelines/standards, bundles and new technology demonstrated to reduce HAIs Health insurance and CMS reimbursement and employee incentive payments tied to quality goals Public reporting of HAIs State and federal laws legislating care issues Greater emphasis on infection prevention by TJC Reduced funds for new infection prevention technologies
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FUTURE OF INFECTION CONTROL
Changing population of hospital patients Increased severity of illness Increased numbers of immunocompromised/older patients Shorter duration of hospitalization More and larger intensive care units Larger step-down units Growing frequency of antimicrobial-resistant and emerging pathogens Lack of compliance with hand hygiene and other infection preventive measures (e.g., endoscope)
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HAZARDS IN THE HOSPITAL
MRSA, VRE,C. difficile, Acinetobacter spp., norovirus Endogenous flora 40-60% Cross-infection (hands): 20-40% Antibiotic driven: 20-25% Other (environment): 20% Weinstein RA. Am J Med 1991;91(suppl 3B):179S
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RISK FACTORS FOR HEALTHCARE-ASSOCIATED INFECTIONS
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More HCPs and more invasive devices = higher HAI rates
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AGING POPULATION, US
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Infection incidence for all categories of HAI per decade of life
Nosocomial Infections in the Elderly Saviteer, Samsa, Rutala. Am J Med 1988;84:661 Infection incidence for all categories of HAI per decade of life
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FUTURE OF INFECTION CONTROL
Changing population of hospital patients Increased severity of illness Increased numbers of immunocompromised/older patients Shorter duration of hospitalization More and larger intensive care units Larger step-down units Growing frequency of antimicrobial-resistant pathogens and emerging pathogen Lack of compliance with hand hygiene and other infection preventive measures (e.g., endoscope)
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EMERGING RESISTANT PATHOGENS: HEALTH CARE FACILITIES
Staphylococcus aureus: Oxacillin (occ. vancomycin, linezolid) Enterococcus: Penicillin, aminoglycosides, vancomycin, linezolid, dalfopristin-quinupristin Enterobacteriaceae: ESBL producers, carbapenems CRE Pseudomonas aeruginosa, Acinetobacter sp: Multi-drug resistant Mycobacterium tuberculosis: MDR (INH, rifampin), XDR (multiple)
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EMERGING INFECTIOUS DISEASES RELEVANT TO THE HOSPITAL
1977 (US) – Legionnaire’s disease 1978 (US) – Staphylococcal toxic shock syndrome 1996 (England US) – Variant Creutzfeld-Jakob disease (vCJD) 2001 (US) - Anthrax (attack via letters)* 2002 (US) – Vancomycin-resistant S. aureus* 2002 (Canada US) – Hypervirulent C. difficile* 2003 (China worldwide) - SARS* * HCWs at risk for infection
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EMERGING INFECTIOUS DISEASES RELEVANT TO THE HOSPITAL
2003 (US) – Monkeypox* 2004 (Asia) – Avian influenza (H5N1)* 2006 (Worldwide) – XDR-TB* 2009 -Novel H1N1 influenza KPC-Klebsiella pneumoniae carbapenemase (KPC) , New Delhi metallo-beta-lactamase (NDM) Enterobacteriaceae, Carbapenen-resistant Enterobacteriaceae (CRE) (Worldwide) – Middle East Respiratory Symptoms-Coronavirus * HCP at risk for infection
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FUTURE OF INFECTION CONTROL
Changing population of hospital patients Increased severity of illness Increased numbers of immunocompromised patients Shorter duration of hospitalization More and larger intensive care units Larger step-down units Growing frequency of antimicrobial-resistant pathogens and emerging pathogen Lack of compliance with hand hygiene and other infection preventive measures (e.g., endoscope)
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RATIONALE FOR HAND HYGIENE
Many infectious agents are acquired via hand contact with contaminated surfaces Contact transmission: healthcare (MRSA, VRE), day care (MRSA), home (MRSA, “cold viruses”, herpes simplex) Fecal-oral transmission: day care (Shigella, E. coli O157:H7), home (Salmonella, E. coli O157:H7, Cryptosporidium) Hand hygiene effective in reducing or eliminating transient flora Hand hygiene demonstrated to be effective in preventing illness (especially fecal-oral diarrheal illnesses) in healthcare facilities, child care centers/homes, and households ~40% of healthcare-associated infections due to cross-transmission
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WHAT IS OUR TRACK RECORD ON HANDWASHING IN HEALTHCARE FACILITIES?
A review of 34 published studies of handwashing adherence among healthcare workers found that adherence rates varied from 5% to 81% The average adherence rate was only 40% Average Handwashing Adherence of Personnel in 34 Studies Average
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ASSOCIATION BETWEEN HAND HYGIENE COMPLIANCE AND HAI RATES
Author, year Setting Results Casewell, 1977 Adult ICU Reduction HAI due to Klebsiella Maki, 1982 Reduction HAI rates Massanari, 1984 Kohen, 1990 Trend to improvement Doebbeling, 1992 Different rates of HAI between 2 agents Webster, 1994 NICU Elimination of MRSA* Zafar, 1995 Newborn Larson, 2000 MICU/NICU 85% reduction VRE Pittet, 2000 Hospitalwide Reduction HAI & MRSA cross-transmission HAI, healthcare-associated infections *Other infection control measures also instituted Boyce JM, Pitter D. MMWR 2002;51(RR-16)
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HAND HYGIENE ADHERENCE AN INSTITUTIONAL PRIORITY
Multidisciplinary Program Administrative support (IOC, Executive Staff, Dept Heads) Monitor HCWs adherence to policy and provide staff with information about performance Provide HCWs with accessible hand hygiene (HH) products to include alcohol based hand rubs Education regarding types of activities that result in hand contamination and indications for hand hygiene Reminders in the workplace (e.g., posters) Considering ways to include HH in management standards (loss of hospital privileges, tickets for non-compliance, coffee coupons)
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UNC HEALTH CARE INTENSIVE CARE UNITS-HAND HYGIENE COMPLIANCE
ICPs Cross-cover Units Evaluated hand hygiene products Leadership presentations Collected baseline data Implemented Infection Control Liaisons Pocket-sized alcohol based gel available Staff HH compliance added to patient satisfaction survey Began quarterly compliance reports to ICUs Ongoing education
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Endoscope Reprocessing: Current Status of Cleaning and Disinfection
Guidelines Multi-Society Guideline, 12 professional organizations, 2011 Centers for Disease Control and Prevention, 2008 Society of Gastroenterology Nurses and Associates, 2010 AAMI Technical Information Report, Endoscope Reprocessing, In preparation Food and Drug Administration, 2009 Endoscope Reprocessing, Health Canada, 2010 Association for Professional in Infection Control and Epidemiology, 2000
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ENDOSCOPE INFECTIONS Infections traced to deficient practices
Inadequate cleaning (clean all channels) Inappropriate/ineffective disinfection (time exposure, perfuse channels, test concentration) Failure to follow recommended disinfection practices (drying, contaminated water bottles, irrigating solutions) Flaws in design/manufacture of endoscopes or AERs
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Endoscope Reprocessing Methods Ofstead , Wetzler, Snyder, Horton, Gastro Nursing 2010; 33:204
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Endoscope Reprocessing Methods Ofstead , Wetzler, Snyder, Horton, Gastro Nursing 2010; 33:204
Performed all 12 steps with only 1.4% of endoscopes using manual versus 75.4% of those processed using AER
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Transmission of Infection by Endoscopy Kovaleva et al
Transmission of Infection by Endoscopy Kovaleva et al. Clin Microbiol Rev : Scope Outbreaks Micro (primary) Pts Contaminated Pts Infected Cause (primary) Upper GI 19 Pa, H. pylori, Salmonella 169 56 Cleaning/Dis-infection (C/D) Sigmoid/Colonoscopy 5 Salmonella, HCV 14 6 Cleaning/Dis-infection ERCP 23 Pa 152 89 C/D, water bottle, AER Bronchoscopy 51 Pa, Mtb, Mycobacteria 778 98 C/D, AER, water Totals 1113 249 Based on outbreak data, if eliminated deficiencies associated with cleaning, disinfection, AER , contaminated water and drying would eliminate about 85% of the outbreaks.
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TRANSMISSION OF INFECTION
Gastrointestinal endoscopy >150 infections transmitted Salmonella sp. and P. aeruginosa Clinical spectrum ranged from colonization to death Bronchoscopy ~100 infections transmitted M. tuberculosis, atypical Mycobacteria, P. aeruginosa Endemic transmission may go unrecognized (e.g., inadequate surveillance, low frequency, asymptomatic infections) Kovaleva et al. Clin Microbiol Rev :
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ENDOSCOPE REPROCESSING: CHALLENGES Susceptibility of Human Papillomavirus J Meyers et al. J Antimicrob Chemother, Epub Feb 2014 Disinfectants (to include HLD) no effect on HPV Finding inconsistent with other small, non-enveloped viruses such as polio and parvovirus Further investigation warranted: test methods unclear; glycine; organic matter; comparison virus Use HLD consistent with FDA-cleared instructions (no alterations)
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ENDOSCOPE REPROCESSING: CHALLENGES NDM-Producing E
ENDOSCOPE REPROCESSING: CHALLENGES NDM-Producing E. coli Associated ERCP MMWR 2014;62:1051 March-July 2013, 9 patients with cultures for New Delhi Metallo-ß-Lactamase producing E. coli associated with ERCP History of undergoing ERCP strongly associated with cases NDM-producing E.coli recovered from elevator channel No lapses in endoscope reprocessing identified Hospital changed from automated HLD to ETO sterilization Due to either failure of personnel to complete required process every time or intrinsic problems with these scopes Recommendations: education/adherence monitoring; enforcement of best practices; define extent of issue; certificate/competency testing; innovation to assess the process; preventive maintenance; follow FDA instructions (no alteration)
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FUTURE OF INFECTION CONTROL
Limited infection prevention resources Implementation of guidelines/standards, bundles and new technology demonstrated to reduce HAIs Health insurance and CMS reimbursement tied to quality goals Public Reporting of HAIs State and federal laws legislating care issues Greater emphasis on infection prevention by The Joint Commission Reduced funds for new infection prevention technologies
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INCREASING DEMANDS ON IPs WITH ACCOUNTABILITY
Public expectation of 0 rate of healthcare-associated infections? Buy in by legislatures and CMS IC accountability and attention rich but resource poor
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IP ACTIVITIES 1975 to 1990 1991 to 2003 (new) Surveillance
Outbreak investigations Exposure evaluations Education JCAHO Policy development and review Sterilizer monitoring Dialysis water 1991 to 2003 (new) Targeted surveillance OSHA TB OSHA Bloodborne Molecular epidemiology MRSA, VRE BT preparedness Construction rounds
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IP ACTIVITIES 2004 to 2012 Future IHI bundles CMS core measures
NSQUIP (VAs, others) NDNQI (ANA) Other CQI initiatives MRSA active surveillance Unannounced TJC visits Avian influenza preparedness Endoscope sampling Future Public health reporting Mandated influenza vaccine Mandated MRSA surveillance Cost analyses Comprehensive surveillance Transparency Electronic medical records Clinical surveillance software systems
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FUTURE OF INFECTION CONTROL
Limited infection prevention resources Implementation of guidelines/standards, bundles and new technology demonstrated to reduce HAIs Health insurance and CMS reimbursement tied to quality goals Public reporting of HAIs State and federal laws legislating care issues Greater emphasis on infection prevention by The Joint Commission Reduced funds for new infection prevention technologies
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SOURCE OF INFECTION PREVENTION STRATEGIES
Centers for Disease Control and Prevention The Joint Commission Centers for Medicare and Medicaid Services Institute for Healthcare Improvement (IHI) Professional Organizations: APIC, SHEA, AAMI, AORN, SGNA, AIA, SGNA, ASGE
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INFECTION PREVENTION STRATEGIES
Centers for Disease Control and Prevention Prevention of Catheter-Associated UTI, 2009 Guideline for D/S in Healthcare Facilities, 2008 Guideline for Isolation Precautions, 2007 Management of MDR Organisms, 2006 Preventing HA Pneumonia, 2003 Environmental Infection Control in HCF, 2003 Hand Hygiene in Healthcare Settings, 2002 Prevention of Intravascular Device-Related Infections, 2002 Prevention of Surgical Site Infections, 1999 Management of Occupational Exposure to HBV, HCV, HIV, 2002 Infection Control in Healthcare Personnel, 1998
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INFECTION PREVENTION STRATEGIES
SHEA Management of HCWs Infected with HBV, HCV, HIV, March 2010 Disinfection and Sterilization of Prion-Contaminated Medical Instruments, February 2010 Compendium of Strategies to Prevent HAIs, October 2008 Surgical Site Infection CLA-Bloodstream Infection Catheter-Associated UTI Ventilator-Associated Pneumonia Clostridium difficile Methicillin-resistant S. aureus
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INSTITUTE FOR HEALTHCARE IMPROVEMENT VAP AND CA-BSI BUNDLES
VAP Bundle Elevation of the head of the bed to between 30 and 45 degrees Daily “sedation vacation” and daily assessment of readiness to extubate Peptic ulcer disease (PUD) prophylaxis Deep venous thrombosis (DVT) prophylaxis (unless contraindicated) CA-BSI Hand hygiene Maximal barrier precautions Chlorhexidine skin antisepsis Optimal catheter site selection, with subclavian vein as the preferred site for non-tunneled catheters Daily review of line necessity, with prompt removal of unnecessary lines
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INFECTION CONTROL INTERVENTIONS
2000: Addition of 2% chlorhexidine/70% isopropyl alcohol (ChoraPrep®) to the central line dressing kit. 2001: Mandatory training for nurses on IV line site care and maintenance. 2003: Full body drape added to central line kit. MD could choose kit containing a catheter impregnated with antiseptic or antibiotic. 2005: 2nd generation impregnated catheter included in all central line kits (except for Neonatal ICU). 2006: Pilot in MICU of IHI bundle to prevent CLA-BSI. 2007: Implementation of the IHI bundle in all ICUs. 2008: Implementation of Infection Control Liaison Program 2009: Implementation of CHG patch.
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UNC HOSPITALS INTENSIVE CARE UNITS, 1999-09 Central Catheter-Associated Bloodstream Infections
Medical Staff education Dressing kit with Chloraprep Custom insertion kits with antiseptic catheters Nursing education IHI CHG Patch
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IMPACT OF UNC REDUCTION IN CLA-BSI, 1999-2008
Infections prevented 887 Deaths prevented (based on attributable mortality) 222 to 266 death preventing (attributable mortality 25% to 30%) Savings (2005 dollars) $20,615,654
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Given the choice of changing human behavior (e. g
Given the choice of changing human behavior (e.g., improving aseptic technique) or designing a better device, the device will always be more successful… Robert A. Weinstein
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CHG PATCH
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PROTECTIVE DISK WITH CHG
Bacteria can recolonize the skin and CHG suppresses regrowth CHG patch provides contact around the insertion site and 7 day continuous release of CHG provides ongoing antimicrobial protection Randomized, controlled trials show CHG patch reduces risk of infection (JAMA 2009;301:1231 and Ann Hematol 2009;88:267)
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CHG SPONGE EFFICACY: RCT IN ADULT ICU PATIENTS
Study design: Accessor-blind, 3x3 factorial, randomized clinical trial Setting: 7 ICUs in 5 French hospitals (age >18 years) Interventions: Use of CHG sponge vs standard dressing; CHG sponge changed every 7 days, standard dressing changed every 3 days Study size: 2,095 patients, 3,778 catheters, 28,931 catheter days Results CHG sponge reduce catheter-related infection (0.6/1000 Pt-d vs 1.1/1000 Pt-d, p=0.03) CHG sponge reduced CLA-BSIs (0.4/1000 Pt-d vs 1.3/1000 Pt-d, HR=0.24) CHG dressings not associated with increased resistance in skin bacteria Rate of CHG dermatitis = 5.3 per 1000 catheters Timsit J-F, et al. JAMA 2009;301:
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ENVIRONMENTAL CONTAMINATION LEADS TO HAIs Suboptimal Cleaning
There is increasing evidence to support the contribution of the environment to disease transmission This supports comprehensive disinfecting regimens (goal is not sterilization) to reduce the risk of acquiring a pathogen from the healthcare environment
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RISK OF ACQUIRING PATHOGEN FROM PRIOR ROOM OCCUPANT~120% JA Otter et al. Am J Infect Control 2013;41:S6-S11 * Prior room occupant infected; ^Any room occupant in prior 2 weeks infected
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Visual assessment-not a reliable indicator of surface cleanliness
MONITORING THE EFFECTIVENESS OF CLEANING Cooper et al. AJIC 2007;35:338 Visual assessment-not a reliable indicator of surface cleanliness ATP bioluminescence-measures organic debris (each unit has own reading scale, < RLU) Microbiological methods-<2.5CFUs/cm2-pass; can be costly and pathogen specific Fluorescent marker
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ROOM DECONTAMINATION UNITS Rutala, Weber. ICHE. 2011;32:743
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ROOM DECONTAMINATION WITH HPV
Study design Before and after study of HPV Outcome C. difficile incidence Results HPV decreased environmental contamination with C. difficile (p<0.001), rates on high incidence floors from 2.28 to 1.28 cases per 1,000 pt days (p=0.047), and throughout the hospital from 1.36 to 0.84 cases per 1,000 pt days (p=0.26) Boyce JM, et al. Infect Control Hosp Epidemiol. 2008;29:
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FUTURE OF INFECTION CONTROL
Limited infection prevention resources Implementation of guidelines/standards, bundles and new technology demonstrated to reduce HAIs Health insurance and CMS reimbursement and employee incentives goals tied to quality goals Public reporting of HAIs State and federal laws legislating care issues Greater emphasis on infection prevention by TJC Reduced funds for new infection prevention technologies
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FUTURE OF INFECTION CONTROL
Health insurance reimbursement (e.g., BCBS) tied to meeting quality goals Employee incentive package involves metrics that are clinically meaningful and measurable. Patient and employee satisfaction goals Fiscal goals, 4% operating margin Quality goals Ventilator-associated pneumonia, 5-10% below past FY Central-line associated bacteremia, 5-10% below past FY Prophylactic antibiotics within one hour of surgical incision Catheter-associated urinary tract infections, 5% below past FY
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INFECTION PREVENTION GOALS (FY 2013)
Reduce CAUTIs (infection rate or total number of CAUTIs) by 5% of CY2012 rate. Target: <0.65/1000 patient days OR <2.51/1000 catheter days FY2013: 0.61/1000 pt days; 2.42/1000 catheter days (10% decrease) Reduce C. difficile HAI rate by 5% of FY12 rate Target: <0.86/1000 patient days FY2013: 0.61/1000 patient days (33% decrease) Increase hand hygiene compliance among staff to 90%. FY2013 ICUs (measured by IPs): 84.3% (n=925/1097) FY2013 housewide (measured by ICLs): 93.1% (n=6759/7257) All observations-92.0% (7684/8354)
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CMS’s Final Rule for FY14 Inpatient Payments Penalize Hospitals 1%
Penalize hospitals with the highest Hospital-Acquired Condition rates a full 1% of their inpatient Medicare revenue, starting in FY15 Use historical data from Hospital Compare First domain-Patient Safety; considers AHRQ patient safety indicator score (35%) Second domain-Infection rates for CLABSI and CAUTI (65%) in FY15; colon and abdominal hysterectomy in FY16 and C. difficile rates in FY17. Problem: no validation of surveillance; no risk-adjustment for patient population; relies on arbitrary cutoffs (lowest quartile)
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FUTURE OF INFECTION CONTROL
Limited infection prevention resources Implementation of guidelines/standards, bundles and new technology demonstrated to reduce HAIs Health insurance and CMS reimbursement and employee incentive payments tied to quality goals Public reporting of HAIs State and federal laws legislating care issues Greater emphasis on infection prevention by The Joint Commission Reduced funds for new infection prevention technologies
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Healthcare Facility HAI Reporting to CMS via NHSN: Current and Proposed Requirements
HAI Event Facility Type Start Date CLABSI Acute Care Hospitals Adult, Pediatric, and Neonatal ICUs January 2011 CAUTI Adult and Pediatric ICUs January 2012 SSI Colon and abdominal hysterectomy procedures I.V. antimicrobial start (proposed) Dialysis Facilities Positive blood culture (proposed) Signs of vascular access infection (proposed) Inpatient Rehabilitation Facilities October 2012 CLABSI (proposed) Long Term Care Hospitals CAUTI (proposed) MRSA Bacteremia Facility-wide January 2013 C. difficile LabID Event HCW Influenza Vaccination Acute Care Hospitals, OP Surgery, ASCs SSI (proposed) Outpatient Surgery/ASCs January 2014 66 66
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Provider Version
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Consumer Version
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CMS – HAI DIAGNOSES FOR WHICH REIMBURSEMENT NOT ALLOWED, FY 2013
Inpatient Prospective Payment System (IPPS)- hospitals do not receive the higher payment for cases when one of the selected conditions is acquired during hospitalization CAUTI Vascular catheter-associated infection SSI-mediastinitis, certain orthopedic procedures (spine, neck, shoulder, elbow), bariatric surgery for obesity, cardiac implantable electronic device
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CHANGING REGULATORY ENVIRONMENT
New paradigm = All HAIs are preventable Public reporting of HAIs Lack of reimbursement for HAIs Public awareness of the issue Problems with paradigm shift Publically reported rates are NOT risk adjusted for patient risk factors Unfunded mandate May impact of accuracy of surveillance No reimbursement for HAIs even if hospital followed all recommended practices
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FUTURE OF INFECTION CONTROL
Limited infection prevention resources Implementation of guidelines/standards, bundles and new technology demonstrated to reduce HAIs Health insurance and CMS reimbursement and employee incentive payments tied to quality goals Public reporting of HAIs State and federal laws legislating care issues MRSA active surveillance Influenza vaccination Greater emphasis on infection prevention by The Joint Commission Reduced funds for new infection prevention technologies
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FUTURE OF INFECTION CONTROL
Limited infection prevention resources Implementation of guidelines/standards, bundles and new technology demonstrated to reduce HAIs Health insurance and CMS reimbursement and employee incentive payments tied to quality goals Public reporting of HAIs State and federal laws legislating care issues Greater emphasis on infection prevention by The Joint Commission (sometimes do not use evidence-based guidelines for citations, e.g., 7-day endoscope reprocessing; risk assessments-1m LLD, 20m Glut) Reduced funds for new infection prevention technologies
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JOINT COMMISSION: NATIONAL PATIENT SAFETY GOALS
Old Comply with CDC hand hygiene guidelines Manage as sentinel events all HAI-related deaths New ( ) Implement evidence-based practices to prevent HAIs due to MDROs (MRSA, VRE, MDR-GNR, C. difficile) Implement evidence-based practices to prevent CLA-BSIs Implement best practices to prevent SSIs Prevent CA-UTIs
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FUTURE OF INFECTION CONTROL
Limited infection prevention resources Implementation of guidelines/standards, bundles and new technology demonstrated to reduce HAIs Health insurance and CMS reimbursement and employee incentive payments tied to quality goals Public reporting of HAIs State and federal laws legislating care issues Greater emphasis on infection prevention by The Joint Commission Reduced funds for new infection prevention technologies
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FUTURE OF INFECTION CONTROL Hospitals-budget cuts, job loses
Hospitals reduce spending (job losses, service reductions) due to reduced revenues (reimbursement for service [2% reduction Medicare], no new volumes) Utilizing new technology to improve outcomes is superior to changing behavior New technology have played a critical role in reducing HAIs (CHG-Alc for SSI, CHG sponge, antiseptic/antibiotic impregnated central lines) Reduced hospital margins will force hospitals to limit investments in new infection prevention technology
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DISCUSSION TOPICS Impact of healthcare-associated infections
Challenges in infection prevention
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CONCLUSIONS Healthcare-associated infections are associated with significant patient morbidity and mortality Implementation of bundles (IHI) and products demonstrated to reduce HAIs (e.g., CLA-BSI) Compliance with infection prevention recommendations needed to prevent HAIs
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CONCLUSIONS Current challenges Increased emphasis on preventing HAIs
Increased demands on IP time Lack of compliance with hand hygiene and guidelines/policies Institution of IHI bundles and other CQI activities Public reporting, mandated vaccines, mandated practices Multidrug pathogens: VRSA, MDR-GNRs, XDR-TB Emerging pathogens: C. difficile, norovirus, H1N1 influenza Public desire for 0 rate of healthcare-associated infections Older and sicker patient population Insurance and CMS reimbursement tied to quality goals (eg, HAI reductions) Reduced hospital margins, reduced investments in new technology
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