presented by: linda r. greene linda [email protected] presentation.pdf · liz garman - vice...
TRANSCRIPT
APIC’s Vision and Mission
Vision: Health care without infection
Mission: Create a safer world through prevention of
infection
Background
Most APIC members are nurses, physicians, public health
professionals, epidemiologists, or medical technologists who:
• Collect, analyze, and interpret health data in order to track infection
trends, plan appropriate interventions, measure success, and report
relevant data to public health agencies
• Establish scientifically based infection prevention practices and
collaborate with the health care team to assure implementation
• Work to prevent HAIs in health care facilities by isolating
sources of infections and limiting their transmission
• Educate health care personnel and the public
More than 14,000 members world wide
Goals
1. Patient Safety Goal
Demonstrate and support effective infection prevention and
control as a key component of patient safety
2. Implementation Science
Promote and facilitate the development and implementation of
scientific research to prevent infection
3. IP competencies and certification goal
Define, develop, strengthen, and sustain competencies of the IP
across the career span and support board certification in infection
prevention and control (CIC®) to obtain widespread adoption
Goals (continued)
4. Advocacy goal
Influence and facilitate legislative, accreditation, and regulatory
agenda for infection prevention with consumers, policy makers, health
care leaders, and personnel across the care continuum
5. Data standardization goal
Promote and advocate for standardized, quality and comparable HAI
data
How Big of a Problem are Healthcare Associated Infections (HAIs) in the U.S.?
• Point Prevalence Survey; National Healthcare Safety Network (NHSN) N=183 hospitals, 2011
• Patients at risk = 11,282 – 452 (4.0%) with > one HAI
– Distribution by site – see pie chart
– C. difficile = 70% of GI infections
• Nationwide estimates:
– 648,000 patients with 721,800 HAIs/year
Magill SS et al. NEJM 2014;370:1198-208
Who Gets HAIs? 1/25 on any given day in U.S.
hospitals; many are older adults
Magill SS, et al. NEJM 2014
APIC Goal Alignment
Objectives and Initiatives
Collaborate and align with key
infection prevention and public health
organizations, agencies and,
consumer groups to demonstrate and
promote effective infection prevention
programs across the care continuum
11th Scope of Work
Teach and advise as technical
experts
• Consultation and education
• The management of knowledge so
learning is never lost
Safety – More than a Model
9
Patient
Leadership
Communication
Teamwork
Managing Behavioral
Choices
Organizational Learning
System Design
New Strategies for the Road Ahead: Products, Practices
+ Social Sciences = Prevention of HAIs
Welsh CA, et al. AJIC 2012
APIC Involvement
National Faculty
CAUTI CUSP Program
Mentorship CAUTI Fellowship Program
Long Term Care CAUTI Program
Ambulatory Surgery Program
Activities
HRET- CAUTI CUSP Project
Recruiting new cohorts for the long term care
Recruiting for Ambulatory Surgery Program
Other Quality Activities
• Legislation
• Communication- patient information www.apic.org
• Surveillance- CDC Task Forces
• Education –webinars
• Publications – AJIC, SHEA Compendium
Lessons Learned
Engage
Educate
Execute
Evaluate
Technical Challenges
• Can be solved with existing science or technology “knowledge
based”
• Issues or challenges for which there is “an answer”
• Examples:
– Summarizing the evidence
– Educating staff and senior leaders
– Evaluation: Are patients safer?
15
Heifetz, Leadership Without Easy Answers (Cambridge:
Harvard University Press, 1994)
Adaptive Challenges
• Require a change of values, attitudes or beliefs
• “Behavior based”
• Examples:
– Engagement
– Execution
16
The Work of Adaptive Change
• Determining the direction – what must change
• Determining the methods - how to change • Local wisdom tapped
Leverage the power and the wisdom of the
front line staff
18
Collaborative Activities
• Technical Aspects
• Adaptive Aspects
Patient Safety Goal
Objectives and Initiatives
Define key processes of care that are
shown to prevent infection
Create tools that integrate elements
of the science of safety into infection
prevention programs
Identify and assess measures that
demonstrate the impact of infection
prevention as part of patient safety
11th Scope of Work
Champion local-level, results-oriented
change
−Data driven
−Active engagement of patients and
other partners
Proactive, intentional innovation and
spread of best practices that “stick
Definition of Spread
“Spreading takes the process from the narrow,
segmented population(s) or group(s) and broadens it to
include all the population(s) or group(s) that will use the
process.”
21
The Pace of Spread
22
• Quick Slow
Diffusion of Innovation
23
E.Rogers, 1962
Sustainability – Projects That Stick
24
• Importance: External (patients, payers, community)
– Internal (organization, staff, providers)
• Evidence of better practice
• Quantitative /qualitative documented gap
• Evidence of successful implementation
– Staff involvement in success
something worth sustaining
Factors that Influence Sustainability
• Effectiveness
• Routinization and integration with existing
programs/services (institutionalization)
• Program champions/leadership (building capacity)
• Socio-political considerations
25
Advocacy Goal
Objectives and Initiatives
Advance the development and adoption
of scientifically valid, actionable, infection
prevention measures and the necessary
technology support that promotes
appropriate data collection
Promote active IP participation and
collaboration with organizational
leadership of providers, consumer
advocacy groups, and payers to
enhance infection prevention and control
on all levels and points of care
11th Scope of Work
Coordinating prevention through HIT
meaningful use
Optimal learning, patient activation,
and sustained behavior change
Reducing care associated Infections
2011
• CAUTI – Acute Care ICUs (except NICUs) (Jan.)
• CAUTI – LTCH, IRF, Cancer Hospitals (Oct)
• SSI – Colon Surgeries and Abdominal Hyst. – Acute Care (Jan)
• Dialysis Events – ESRD (Jan)
• CLABSI – LTCH, Cancer Hospitals (Oct)
2012
2013
• HCP Influenza Vaccination – ASCs, Hosp. Outpt. Depts., IRF (Oct.)
• SSI – Cancer Hospitals (Jan.) 2014
• CLABSI – Acute Care ICUs (Jan.)
• C. Diff – Acute Care (Jan.)
• MRSA Bacteremia – Acute Care (Jan.)
• HCP Influenza Vaccination – Acute Care (Jan.)
• HCP Influenza Vaccination – LTCH (Jan.)
2015
Federal HAI Reporting to NHSN
• CLABSI – Acute Care Med, Surg, Med/Surg Units (Jan.)
• CAUTI – Acute Care Med, Surg, Med/Surg Units (Jan.)
• MRSA Bacteremia – LTCH (Jan.), IRF (Jan.)
• C. Diff – LTCH (Jan.), IRF (Jan.)
• HCP Influenza Vaccination – Inpt. Psych. Fac. (Oct.), ESRD (Oct.) proposed
• VAE – LTCH (Jan.) 2016
August 20, 2014
Metric Baseline Source Target Update
Central Line-Associated Bloodstream
Infections
2006/
2008
NHSN/SIR 50% reduction
in ICU and ward-located
patients
44% reduction
(SIR = .56)
Invasive MRSA infections (population) 2007/
2008
EIP/ABC 50% reduction
in incidence of
healthcare-associated
invasive MRSA infections
31% reduction*
Surgical Site Infections 2006/
2008
NHSN/SIR 25% reduction
in SSIs following SCIP-
like procedures on
admission or readmission
20% reduction*
(SIR =.80)
Hospital-Onset Clostridium difficile
infections
2010/
2011
NHSN/SIR 30% reduction
in facility-wide inpatient
healthcare facility-onset
C. diff. LabID Events
2% reduction
(SIR = .98)
Hospital-Onset MRSA bacteremia 2010/
2011
NHSN/SIR 25% reduction
in facility-wide inpatient
healthcare facility-onset
MRSA blood LabID
Events
3% reduction
(SIR = .97)
Catheter-Associated Urinary Tract
Infections
2009 NHSN/SIR 25% reduction
in ICU and ward-located
patients
2% increase
(SIR =1.02)
Clostridium difficile (hospitalizations) 2008 HCUP 30% reduction
in hospitalizations with C.
diff.
22% increase%**
Note: Information based on federal agency presentations at National Action Plan to Prevent HAI’s meeting on September 25 and 26, 2013.
*Estimate based on preliminary 2012 data when noted in the presentation. **Projection for 2013.
Abbreviations:
EIP/ABC is the CDC’s Emerging Infections Program Antibacterial Core Surveillance program.
NHSN is the CDC’s National Healthcare Safety Network.
SIR is Standardized Infection Ratio which is observed # of HAIs/predicted # of HAIs
HCUP is AHRQ’s Healthcare Cost and Utilization Project , an all-payer inpatient care database which uses an ICD-9 code for c. difficile.
National Action Plan to Prevent HAIs
September Progress Report on Outcome Measures for Acute Care
CLABSI
• More prevention in ICUs compared to wards – need to explore best practices for CLABSI
prevention outside the ICU
• Research is needed to assess the current proportion of CLABSIs that are not preventable
CAUTI
• Reduce catheter use
• Broad implementation of best practices for catheter insertion
• Increase focus on catheter maintenance
• Education on appropriateness of diagnostic testing (urine cultures)
SSI
• Implement updated recommendations for SSI Prevention from upcoming HICPAC guideline
• Collaborate with external partners to produce procedure-specific recommendations for surveillance
and prevention
MRSA
• Expand MRSA prevention efforts to healthcare-associated community onset cases
C. difficile:
• Improve antimicrobial use in inpatient settings
• Improve environmental decontamination
Opportunities for Improvement
Drawn from CDC recommendations at the 9/25&26/2013 meeting
QIOs
• Statewide partners and initiatives (APIC, DPHs, Associations,
etc )
• Face-to-face interaction and technical support
• Innovative Approaches
• IP training
• Leadership support due to history of community relationships
Reasons for Collaboration
• Shared vision and priorities
• Mutual respect
• Complimentary strengths
• Teamwork and communications
Collaborative Opportunities
Link and align efforts
QIO experience with quality metrics
Learning opportunities
Continue to work with APIC state and local chapters
Identify further collaborative work and learning opportunities
Regional efforts
Focus on Implementation Science
Shared Journey- learning opportunities
Lean Sigma
Innovation
Different Direction
• Contextual Journey
• INSIDE OUT
• Observe then define
• Observation for
understanding
• Anthropology foundation
• Solutions are uncovered,
guided by insiders, those
directly involved-creates
ownership
• Traditional Journey
• OUTSIDE IN
• Define, then observe
• Observation for compliance
• Manufacturing foundation
• Solutions are pre-defined,
guided by outsiders, those
indirectly involved-buy-in
Our New Journey
How do we get there?
COLLABORATION
APIC Contacts
Katrina Crist – CEO APIC [email protected]
Lisa Tomlinson –Vice President, Government Affairs and
Practice Guidance [email protected]
Liz Garman - Vice President, Communications
Leslie Kretzu -Executive Director APIC Consulting Services,
Inc. [email protected]