Healthcare Associated InfectionsIssues, trends, and resources for combating the problem.

Nancy Hudecek RN, BSN, MSDirector, Risk Management, Patient Safety, and Quality Improvement

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1.7 Million Cases and 99,000 deaths annually

32 percent are urinary tract infections 22 percent are surgical site infections 15 percent are pneumonia (lung infections) 14 percent are bloodstream infections

Scope of the Problem

Catheter-Associated Urinary Tract Infection Comprise 32% of all HAIs; average cost is $3,200 Duration is most important patient risk (3-7% per day) 26% of patients cathed 2-10 days develop bacteriuria 24% of patients with bacteriuria will develop CAUTI 3% of patients with CAUTI will develop bacteremia Most infections are asymptomatic Staff must understand caregiver risk factors

CAUTI

Surgical Site Infections comprise 22% of all HAIs Develop within 30 days of operation (1 year

w/implant) Up to 5% of surgical patients; average cost is $25,000 SSI HAIs on Hospital Acquired Conditions “List”◦Mediastinitis following CABG◦ SSI following Bariatric Surgery including Laparoscopic Gastric

Bypass or Restrictive Surgery and Gastroenterostomy◦ SSI following Orthopedic Procedures of Spine, Neck, Shoulder

and Elbow Staff must understand caregiver risk factors

SSI

Pneumonia comprises 15% of all HAIs and Ventilator-Associated Pneumonia increases risk 6-21% VAP occurs in 8-28% of MV patients; cost $49,000 Usually occurs within 4 days of intubation Overall rate 1-4 cases per 1,000 ventilator days Rate varies by hospital area, highest in burn, trauma,

neuro/neurosurgical and surgical care patients Most commonly caused by S Aureus and Pseudomonas Staff must understand risk factors

VAP

Catheter-Related Bloodstream Infections Comprise 14% of HAIs and cost $34,500-$56,000 CRBSI rates vary depending on the type of catheter

used and the patient's underlying condition. CVC BSI rate 5.3 per 1000 catheter days in the ICU Common pathogens are staph and enterococcus Staff education makes a difference in prevention

CRBSI

Human Impact Direct medical costs range from $35.7 to $45 billion Hospital-Acquired Conditions (HAC) and Present on

Admission (POA) Indicator Reporting Inpatient Prospective Payment System (IPPS) “Quality adjustment” to hospital payments No additional pay for HACs and HAIs

Financial Considerations of HAI

Antibiotic Resistance“Superbugs”

MRSA Up CloseMethicillin-resistant Staphylococcus aureus

VirulenceFrequency, Severity and Mortality

Clostridium DifficileBacilli on the left, colonies on the right

Prevention Education Surveillance

Keys to Eliminating HAIs

APIC on HealthStream

Elimination of Catheter-Associated Urinary Tract Infections in Hospital Settings

Elimination of Surgical Site Infections in Hospital Settings Elimination of Ventilator-Associated Pneumonia in

Hospital Settings Elimination of CR-BSI in Hospital Settings

Elimination of MRSA in Hospital Settings Elimination of C. difficile in Hospital Settings

APIC Library

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