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NQF-Endorsed® Safe Practices for Better Healthcare Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections © 2010 TMIT 1 Slide Deck Overview Slide Set Includes: Section 1: Section 2: Section 3: Section 4: Section 5: Section 6: © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX NQF-Endorsed® Safe Practices for Better Healthcare Overview Harmonization Partners The Problem Practice Specifications Example Implementation Approaches Front-line Resources 2 NQF-Endorsed® Safe Practices for Better Healthcare Overview Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections © 2010 TMIT 3 2010 NQF Safe Practices for Better Healthcare: A Consensus Report 34 Safe Practices • Criteria for Inclusion • Specificity • Benefit • Evidence of Effectiveness • Generalization • Readiness © 2010 TMIT 4 Culture SP 1 2010 NQF Report © 2010 TMIT 5 Culture Structures and Systems Culture Meas., FB., and Interv. Team Training and Skill Bldg. Risk and Hazards CHAPTER 2: Creating and Sustaining a Culture of Safety (Separated into Practices] Culture of Safety Leadership Structures and Systems Culture Measurement, Feedback, and Intervention Teamwork Training and Skill Building Risks and Hazards Consent & Disclosure Consent and Informed Consent Life-Sustaining Treatment Care of Caregiver Disclosure Workforce Nursing Workforce Direct Caregivers CHAPTER 4: Workforce • Nursing Workforce • Direct Caregivers • ICU Care ICU Care Information Management and Continuity of Care Patient Care Info. Read-Back & Abbrev. Labeling Diag. Studies Discharge Systems CHAPTER 3: Consent and Disclosure • Informed Consent • Life-Sustaining Treatment • Disclosure • Care of the Caregiver CPOE Medication Management CHAPTER 5: Information Management and Continuity of Care Patient Care Information Order Read-Back and Abbreviations Labeling Diagnostic Studies Discharge Systems Safe Adoption of Computerized Prescriber Order Entry CHAPTER 6: Medication Management Medication Reconciliation Pharmacist Leadership Structures and Systems Med. Recon. Pharmacist Leadership Structures and Systems Healthcare-Associated Infections Influenza Prevention Hand Hygiene Sx-Site Inf. Prevention VAP Prevention Central Line-Assoc. BSI Prevention MDRO Prevention UTI Prevention Condition- and Site-Specific Practices Wrong-site Sx Prevention Contrast Media Use Organ Donation Press. Ulcer Prevention Glycemic Control VTE Prevention Falls Prevention Anticoag. Therapy Pediatric Imaging CHAPTER 7: Healthcare-Associated Infections • Hand Hygiene • Influenza Prevention • Central Line-Associated Blood Stream Infection Prevention • Surgical-Site Infection Prevention • Daily Care of the Ventilated Patient • MDRO Prevention • Catheter-Associated UTI Prevention CHAPTER 8: Condition- and Site-Specific Practices • Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention • Pressure Ulcer Prevention • VTE Prevention • Anticoagulation Therapy • Contrast Media-Induced Renal Failure Prevention • Organ Donation • Glycemic Control • Falls Prevention • Pediatric Imaging Harmonization Partners Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections © 2010 TMIT 7 Harmonization – The Quality Choir © 2010 TMIT 8 The Patient – Our Conductor © 2010 TMIT 9 The Objective Multidrug-Resistant Organism Prevention Prevent healthcare-associated multidrug-resistant organism (MDRO) infections, including methicillinresistant Staphylococcus aureus (S. aureus) (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile infections (CDIs) © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 10 The Problem Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections © 2010 TMIT 11 The Problem © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 12 [http://query.nytimes.com/gst/fullpage.html?res=9E01E4D9173AF937A25757C0A96F9C8B63] © 2010 TMIT 13 [http://www.latimes.com/features/health/la-sci-badbugs17-2009feb17,0,5079716.story] © 2010 TMIT 14 [http://www.infectiousdiseasenews.com/article/59402.aspx] © 2010 TMIT 15 The Problem Frequency MRSA accounts for more than 50% of hospitalacquired S. aureus infections 82% of hospitals have not seen CDI rates decrease in the past 3 years Doubling of hospital discharges with CDIs from 2001 to 2005 Increase to more than 300,000 CDI cases in 2005 [NNIS, Am J Infect Control 2004 Dec;32(8):470-85; Jarvis, Am J Infect Control 2009 May;37(4):263-70; Carrico, Guide to the Elimination of Clostridium difficile in Healthcare Settings, 2008] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 16 The Problem Severity More than 5,000 deaths each year are attributable to MRSA Attributable mortality rate of 6.9% at 30 days and 16.7% at 1 year [Institute for Healthcare Improvement, 5 Million Lives Campaign, 2008; Levinson, Adverse events in hospitals: state reporting systems, 2008; Loo, N Engl J Med 2005 Dec 8;353(23):2442-9; Muto, Infect Control Hosp Epidemiol 2005 Mar;26(3):273-80; Pépin, Clin Infect Dis 2005 Nov 1;41(9):1254-60] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 17 The Problem Preventability 40% reduction in MDROs by implementing a checklist for hospital interventions A notification system should be established in a timely manner The decrease in MDROs will also lead to a decline in other infections [Siegel, Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006; Siegel, Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings, 2007; Abbett, Infect Control Hosp Epidemiol 2009 Nov; 30(11):1062-9; Dubberke, Infect Control Hosp Epidemiol 2009 Jun;30(6):518-25; O’Dowd, BMJ 2009 Jun 26;338:b2580] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 18 The Problem Cost Impact Additional cost of $39K per case in patients with a MRSA surgical-site infection Mortality rates were 13% higher in patients with MRSA infection Hospital costs due to CDI range from $6.4K to $9.1K in 2007 dollars [Engemann, Clin Infect Dis 2003 Mar 1;36(5):592-8; Scott, The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2009] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 19 Practice Specifications Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections © 2010 TMIT 20 Additional Specifications © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 21 Safe Practice Statement Multidrug-Resistant Organism Prevention Implement a systematic multidrug-resistant organism (MDRO) eradication program built upon the fundamental elements of infection control, an evidence-based approach, assurance of the hospital staff and independent practitioner readiness, and a re-engineered identification and care process for those patients with or at risk for MDRO infections © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 22 Additional Specifications The organization’s leadership has assigned responsibility of the development, testing, and implementation of an MDRO prevention program Conduct a risk assessment for MDRO acquisition and transmission Educate staff and licensed independent practitioners about MDROs, including risk factors, routes of transmission, outcomes associated with infection, prevention measures, and local epidemiology [Siegel, Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006; Calfee, Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S62-80; Dubberke, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S81-92; Joint Commission Resources, National Patient Safety Goal NPSG.07.03.01, 2010; Institute for Healthcare Improvement, Infection Prevention, IHI Improvement Map, 2009; Seto, J Hosp Infect 1995 Jun;30 Suppl:241-7; TMIT, MRSA: For the Birds, or Pandemic Potential?, 2008] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 23 Additional Specifications Educate patients colonized with MRSA and their families about healthcare-associated infections and infection prevention strategies Implement a surveillance program for MDROs based on risk assessment Measure and monitor MDRO prevention processes and outcomes Provide MDRO surveillance data, prevention processes, and outcome measures to key stakeholders [Lewis, J Hosp Infect 1999 Sep;43(1):19-23; NHSN, Multidrug-resistant Organism and Clostridium difficile-Associated Disease Module, 2009 ; Calfee, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S62-80] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 24 Additional Specifications Implement a system to provide immediate notification about newly diagnosed MDROcolonized or -infected patients Implement an alert system that identifies readmitted or transferred MRSA-colonized or -infected patients Promote compliance with hand hygiene recommendations Use contact precautions for MDRO-colonized or infected patients Ensure cleaning and disinfection of equipment and environment [Boyce, Infect Control Hosp Epidemiol 2009 Jun;30(6):515-7; Johnson, Med J Aust 2005 Nov 21;183(10):509-14; Centers for Disease Control and Prevention, Preventing Transmission of Infectious Agents in Healthcare Settings, 2007; D’Agata, Clin Infect Dis 2009 Feb 1;48(3):274-84; Institute for Healthcare Improvement, Standard Precautions: IHI Improvement Map, 2009; Lederer, Jt Comm J Qual Patient Saf 2009 Apr;35(4):180-5; Salgado, Am J Infect Control 2009 Feb 23] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 25 Example Implementation Approaches Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections © 2010 TMIT 26 Example Implementation Approaches © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 27 Example Implementation Approaches Place patients with MDRO on contact precautions to reduce patient-to-patient spread of the organism within the hospital Ensure cleaning and disinfection of equipment and the environment Implement an MRSA active surveillance program Initiate an antimicrobial stewardship program [Calfee, Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S62-80; Agency for Healthcare Research and Quality, National Healthcare Quality Report 2008, 2009; Institute for Healthcare Improvement, Antibiotic Stewardship, IHI Improvement Map, 2009; Weber, What Every Health Care Executive Should Know: The Cost of Antibiotic Resistance, 2009] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 28 Example Implementation Approaches Strategies of Progressive Organizations Readiness of hospital staff and independent practitioners: For program success, there must be a culture change Accountability of leaders and their staff is absolutely necessary in order to decrease MDRO infections and prevent needless morbidity and mortality Hospital leadership performs tracers [Humphreys, Clin Microbiol Infect 2009 Feb;15(2):120-4; Mears, J Hosp Infect 2009 Apr;71(4):307-13] © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 29 Front-line Resources Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections © 2010 TMIT 30 [http://www.shea-online.org/about/compendium.cfm; http://www.ncbi.nlm.nih.gov/pubmed/18840091] © 2010 TMIT 31 [http://www.ncbi.nlm.nih.gov/pubmed/18840090] © 2010 TMIT 32 [http://www.cdc.gov/media/pressrel/2010/s100202.htm] © 2010 TMIT 33 [http://www.shea-online.org/Assets/files/patient%20guides/NNL_C-Diff.pdf] © 2010 TMIT 34 [http://www.shea-online.org/Assets/files/patient%20guides/NNL_MRSA.pdf] © 2010 TMIT 35 [http://www.jointcommission.org/PatientSafety/SpeakUp/] © 2010 TMIT 36 Poster available in Spanish TMIT National Webinar Series Healthcare-Associated Infection and You: Cleaner, Safer Care (Safe Practices 19-25) Kathy Warye – Topic: Perspective on the Development of the Implementation Examples of the NQF Safe Practices Peter Angood, MD – Topic: HAI National Attention and Harmonization David Classen, MD – Topic: HAI Compendium Harmonization with the Safe Practices Julianne Morath, RN – Topic: Implementation Jennifer Dingman – Topic: Call to Action Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4932 (May 14, 2009) © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 37 TMIT National Webinar Series MRSA: For the Birds, or Pandemic Potential? (Safe Practice 22) Cheryl Ann Creen, RN, MSN – MRSA Prevention Coordinator, VA Pittsburgh Healthcare Candace Cunningham, RN – MRSA Prevention Coordinator, Acute Care, VA Pittsburgh Healthcare System Jan Englebright, PhD, RN – Chief Nursing Officer, HCA Jason Hickok, MBA, RN – Director, Critical Care & Infection Prevention, Clinical Services Group, HCA Jonathan Perlin, MD – Chief Medical Officer, HCA Go to: http://www.safetyleaders.org/pages/idPage.jsp?ID=4877 (April 8, 2008) © 2010 TMIT © 2006 HCC, Inc. CD000000-0000XX 38