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									        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

                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


www.apic.org/.../PracticeGuidance/GuidelinesStandards/APICCostCalculator-Lit051011.xls




                                                                                         5
    HAI Overview

    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,
2002. Public Health Rep. 2007; 122:160-167. http://www.cdc.gov/ncidod/dhqp/pdf/hicpac/infections_deaths.pdf




                                                                                                                         6
Financial Imact of HAI

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.




                             7
Reporting HAI’s

National Healthcare Safety Network
Data Collection
• The NHSN will become the national repository of data
• The infection prevention department is usually responsible
 for reporting data into NHSN
• Data will be available on a facility, state, and national level

• Resource Page for NHSN:




                                                                    8
Improving Individual Patient
           Care


    Central Line Associated
    Bloodstream Infections
           CLABSI’s
Financial Impact


Infection Type                                              2005 Mean Costs
CLABSI                                                      $18,432*




*Perenchvich EN, et al.Infect Control Hosp EPID Oct. 2007
**APIC Cost of Hospital-Associated Infections Model
***TMIT Cost of HAI Calculator



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CLABSI Background
• 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


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 CLABSI Overview
                     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, 2011 - Central Line Associated Blood Stream Infections, United States, 2001. 2008, 2009




                                                                                                                                 12
CLABSI Overview




                  13
CLABSI – Project Goals


           Measure                Project Target
                                          50%
   CLABSI relative improvement

   CLABSI SIR                             ≤ 1.0

   CLABSI incident rate          ≤ 1.0/1000 central line
                                           days

   CLIP Adherence Rate                   100%




                                                           14
Central Line Insertion Practices (CLIP)

         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.




                                                           15
Sources for CLABSI Guidelines
Sources of CLABSI Guidelines

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




                                                          17
What do we do here at (hospital
          name) ?
Our current central-line policy is as follows:

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?




                                                 19
Our current central-line procedure is as
follows
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)




                                                20
Our results are as follows
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.

                                                          21
Our Improvement Plan is as follows
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.



                                                 22
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-AIM7.1-12-08




                                                                                                                   Template 1/13/2012
  For more information
        IPRO Contacts               Hospital Contacts

Karline Roberts            Fill in the names of your hospital
(518) 320-3508             contacts
kroberts@nyqio.sdps.org

Bill Gardiner
(518) 320-3505
wgardiner@nyqio.sdps.org

Crystal Isaacs
(516) 209-5589
cisaacs@nyqio.sdps.org

Chad Wagoner
(518) 320-3552
cwagoner@nyqio.sdps.org

Teré Dickson, MD
tdickson@nyqio.sdps.org
(516) 209-5324




                                                           Template 1/13/2012

								
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