Look closely at processes to prevent these hospital-acquired infections
Look closely at processes to prevent these hospital-acquired infections
New 2009 NPSGs call for evidence-based practices
Health care-associated infections due to multiple drug-resistant organisms, central line-associated bloodstream infections, and surgical site infections. The Joint Commission's new National Patient Safety Goals (NPSGs) for 2009 require you to implement evidence-based practices to prevent all three of these.
"We are seeing the addition of three NPSG requirements and a multitude of IEs [implementation expectations], all related to reducing the risk of health care-associated infections," says Kathleen Catalano, RN, JD, director of health care transformation support for Plano, TX-based Perot Systems Corp.
The new NPSGs — 7C, 7D, and 7E — will definitely need to be implemented through the combined efforts of the infection control, patient care, and quality departments, says Catalano.
"I believe it is helpful that there is a one-year phase-in period," she says.
This means that during 2009, organizations will have the opportunity to meet milestones to assist them in going live with the NPSGs on Jan. 1, 2010. The milestones are set at three, six, and nine months, and are planning, development, and testing, respectively. The IEs spell out exactly what is expected at each phase.
First, you need to determine what your organization is currently doing to prevent health care-associated infections. "From there, the organization can determine what needs to be done," says Catalano. "Also, I would review any previous recommendations from the state or The Joint Commission findings regarding infection control, and see if any of these impact these goals."
Review your current policies and procedures pertinent to the new NPSGs and see "how far afield the policy is to what is soon to be required," says Catalano. Also, develop a plan on how the organization will meet the milestone deadlines.
"We welcome the additional focus on preventing hospital-acquired infections," says Wayne Bohenek, vice president of patient safety and pharmacy excellence at Catholic Healthcare Partners in Cincinnati, OH. The hospital is in the middle of a systemwide implementation of an electronic surveillance program for early identification and prevention of hospital-acquired infections.
"Each of the new goals requires a comprehensive approach, including changes in practice, improved communication, and technology," says Bohenek. "Our infection control experts work together to identify best practices and spread the learnings."
Preventing deadly health care infections will be the most challenging of all the new NPSGs, says Cynthia McNeill-McDonald, vice president of quality at FirstHealth of the Carolinas. "This brings preventing hospital-acquired infections to a whole new level," she says.
For example, NPSG 7C — which calls for prevention of multiple drug-resistant organisms infections with a focus on methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile-associated disease (CDAD), and vancomycin-resistant enterococci — has 13 IEs.
These include:
- education of health care workers, patients, and families;
- implementation of hand hygiene guidelines;
- contact precautions for patients with MRSA and CDAD;
- a MRSA surveillance program;
- implementation of a laboratory-based alert system that identifies new patients with MRSA;
- a CDAD surveillance program;
- effective cleaning and disinfection of both patient care equipment and the patient care environment.
However, currently most hospitals do not screen every patient for MRSA on admission — some screen only high-risk patients and some do not screen any, notes McNeill-McDonald. You also will have to determine which patients actually acquired MRSA in the hospital.
If a patient did acquire MRSA in the hospital, you must determine where it came from: Was the room not cleaned thoroughly? Did one nurse have a patient that carried MRSA, and did she give it to the next inadvertently?
"We are budgeting a system to be able to check all patients for MRSA on admission, at least high-risk patients," says McNeill-McDonald. "We will also track patients who have MRSA by room and check to make sure that the rooms are cleaned. If any patient acquires MRSA, we will double check to see where they have been exposed."
Data will have to be collected for the following, says McNeill-McDonald:
- hand-washing percentages;
- the percentage of MRSA patients with positive MRSA on admission;
- more detailed analysis on patients who acquire MRSA and other hospital-acquired infections.
NPSG 7E and its 12 IEs pertain to the perioperative areas and any other area in which invasive procedures are performed. "Here, the proposed goal is to implement best practices for prevention of surgical-site infections," says Catalano.
"Infection control, perioperative areas, and the quality department will need to work together to be certain that SSI rates are measured, compliance with best practices is monitored, and the overall effectiveness of prevention efforts are evaluated."
ICU infections cut 80%
NPSG 7D requires implementation of best practices for the prevention of catheter-associated bloodstream infections. "There are 17 IEs for this NPSG, and all should be the practice in hospitals today," says Catalano.
In 2002, University of Pittsburgh Medical Center recognized the need to focus on prevention of central line infections in its intensive care units (ICUs). "A multidisciplinary team of clinicians was successful in that effort," says Kathy Hale, director of patient safety. "We reduced central line infections across all the ICUs in our health system by more than 80%."
Data on all central lines in ICUs are presented to the hospital's infection control committee and to senior leadership each month. This is done as part of a clinical report card using a red, yellow, and green color scheme, with red indicating that the goal wasn't met, yellow indicating that the goal was close to being met, and green meaning that the goal was met or exceeded.
Included in the tracking data is the date, time, and location of insertion; the reason for the line; and patient-specific information on diagnosis and pre-existing infections. The bedside staff complete a procedure note each time a line is placed and must include information on site prep and barrier use.
"Our infection rate is now less than one per 1,000 central line days," says Hale. "We took the things we learned from that experience and applied them to bringing down other types of infection rates."
For example, having "secret shoppers" do direct observation of staff hand hygiene and then letting the staff know what was observed, good or bad, has helped with compliance. "We all know how much hand hygiene can impact infection rates," says Hale.
Currently, a newly created multidisciplinary infection control expert team is working to assess compliance with best practices for prevention of CDAD infections, multiple drug-resistant organisms, ventilator-associated pneumonias, and catheter-associated urinary tract infections. "This is a long-term project whose impact we expect to see far into the future," says Hale.
In addition, Pennsylvania passed a law that went into effect on Jan. 1, 2008, requiring that hospitals recognize, track, trend, and report health care-associated infections to a statewide database and notify patients. "Our own project helped prepare us for the state reporting requirements and for this NPSG," says Hale.
The law requires the hospital to report health care-associated infections to the state's Patient Safety Authority. "We have opted to use an infection tracking software system, which interfaces with our laboratory system for consistency in identifying infections across our system," says Hale.
Reporting is done via the Centers for Disease Control and Prevention's National Healthcare Safety Network database, which has an interface with the state's Patient Safety Authority database.
"So our compliance with the law is accomplished via the interface," says Hale. "There was training needed for all the electronic data aspects of the reporting, but no additional staff was needed."
Hospital-acquired infections are also tracked in the hospital's incident reporting database so that trends can be identified by categories such as bloodstream infections or MRSA colonization. "I think being transparent and having our infection information readily available helps keep staff focused on the NPSGs," says Hale.
[For more information, contact:
Wayne Bohenek, VP Patient Safety and Pharmacy Excellence, Catholic Healthcare Partners, 615 Elsinore Place, Cincinnati, OH 45202. Phone: (513) 639-0115. E-mail: [email protected].
Kathleen Catalano, RN, JD, Director of Healthcare Transformation, Perot Systems, 2300 W. Plano Parkway, Plano, TX 75075. Phone: (972) 577-6213. E-mail: [email protected].
Kathy Hale, Director of Patient Safety, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213-2582. Phone: (412) 647-3052. E-mail: [email protected].
Cindy McNeill-McDonald, Vice President of Quality, FirstHealth of the Carolinas. Phone: (910) 715-1593. E-mail: [email protected].]
Health care-associated infections due to multiple drug-resistant organisms, central line-associated bloodstream infections, and surgical site infections. The Joint Commission's new National Patient Safety Goals (NPSGs) for 2009 require you to implement evidence-based practices to prevent all three of these.Subscribe Now for Access
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