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Moving Beyond Standard Measures for HAI Prevention

Moving Beyond Standard Measures for HAI Prevention. Sue Barnes RN, CIC National Program Leader Infection Prevention & Control Kaiser Permanente. Disclosures. Sue Barnes: none. Learning Objectives. Describe how to access the KP Plus Measures Toolkit, and what it includes.

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Moving Beyond Standard Measures for HAI Prevention

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  1. Moving Beyond Standard Measures for HAI Prevention Sue Barnes RN, CIC National Program Leader Infection Prevention & Control Kaiser Permanente

  2. Disclosures Sue Barnes: none

  3. Learning Objectives • Describe how to access the KP Plus Measures Toolkit, and what it includes. • Explain the difference between standard measures and “plus” measures. • List two “plus measures” designed to reduce the risk of surgical site infections

  4. Gross pictures can sometimes help

  5. More than one picture is even better

  6. Sometimes the more the better

  7. Estimates of costs/mortality associated with infections

  8. Facility specific costs

  9. APIC Cost Calculator online http://www.apic.org/Content/NavigationMenu/PracticeGuidance/GuidelinesStandards/TMIT_V1_CostCalculator02082011.xls

  10. Patient stories

  11. This video clip is available to you on an external accessible KP web page: http://nursingpathways.kp.org/national/quality/infectioncontrol/toolkit/index.html

  12. Small test of change approach Perfecting one batch of cookies Perfecting mass production Perfecting one cookie

  13. Clostridium difficile (CDI)

  14. Universal glove use - CDI “Universal glove use could close gaps left by incomplete adherence to hand hygiene.” Weinstein RA Vol 7 No 2 March April 2001 Emerging Infectious Diseases

  15. CLABSI (central line associated bloodstream infection )

  16. CLABSI continued

  17. Culture of a patient’s port surface Courtesy of Wendy Kaler, MPH, CIC

  18. Making it Personal… Our IV TEAM Lead posing as a patient Courtesy of Wendy Kaler, MPH, CIC

  19. Port Protectors/ Hub Disinfectors A bedside delivery system Courtesy of Wendy Kaler, MPH, CIC

  20. Antiseptic patient bathing • Impregnated bathing cloths (preferred) or liquid chlorhexidine • All patients in ICU, in contact precautions, and with central lines. Mangram A et al. The Hospital Infection Control Practices Advisory Committee. CDC Guidelines for Prevention of Surgical Site Infection 1999. “Require patients to shower or bathe with an antiseptic agent on at least the night before the operative day. Category IB.

  21. SSI (surgical site infection)

  22. SSI continued

  23. OR Observations “Almost no matter what experimental conditions were imposed, increases in output occurred….The investigators had obviously influenced the subjects’ behavior merely by studying that behavior, and this phenomenon has become known as the Hawthorne effect.” (Kelly Shaver, Principles of Social Psychology, 2nd ed., Winthrop, 1981)

  24. Excerpt

  25. AORN/APIC ASC toolkit Overview: The San Francisco/Marin APIC and AORN chapters are collaborating on a project to support Ambulatory Surgery Centers in preventing surgical site infections by offering an online toolkit/library of resources, and with voluntary onsite consultative team visits. Toolkit/library contents: http://www.aboutinfectioncontrol.com/SubWebs/APIC/MAIN_Toolkits.htm

  26. And you thought your job was hard

  27. VAP (ventilator associated pneumonia )

  28. VAP continued

  29. Oral care with CHG rinse “Oral care reduces incidence of ventilator-associated pneumonia in ICU populations” Mori H, Hirasawa H, Oda S, et al.. Intensive Care Medicine. 2006;15:1-7.

  30. CAUTI (catheter associated urinary tract infection)

  31. Bladder ultrasound Topal J. “Prevention of Nosocomial Catheter-Associated Urinary Tract Infections Through Computerized Feedback to Physicians and a Nurse-Directed Protocol”. American Journal of Medical Quality, Vol. 20, No. 3, 121-126 (2005)

  32. MRSA (methicillin resistant Staph aureus )

  33. Physician hand hygiene observations Pittet D et al. : The World Health Organization hand hygiene observation method.” Am J Infect Control. 2009 Dec;37(10):827-34.

  34. Plus Measures impacting more than one type of HAI MD Hand hygiene observations Antiseptic (CHG) patient bathing Improved environmental cleaning and quality assessment

  35. RESOURCES: KP Infection Prevention “Plus Measures” Toolkit http://nursingpathways.kp.org/national/quality/infectioncontrol/toolkit/index.html AORN/APIC ASC Toolkit/library contentshttp://www.aboutinfectioncontrol.com/SubWebs/APIC/MAIN_Toolkits.htm APIC Cost Calculator http://www.apic.org/Content/NavigationMenu/PracticeGuidance/GuidelinesStandards/TMIT_V1_CostCalculator02082011.xls APIC/SHEA Compendium http://www.shea-online.org/GuidelinesResources/CompendiumofStrategiestoPreventHAIs.aspx Patient Story Video Clip http://nursingpathways.kp.org/national/quality/infectioncontrol/toolkit/index.html

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