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1. Susan J. Rehm, M.D.
Vice Chair
Department of Infectious Disease
2. The Cleveland Clinic
3. System Hospitals
4. Location, Location, Location
5. The Cleveland Clinic 40,00 employees
Electronic medical record in use for outpatients; gradual implementation for inpatients
Use of intranet makes sense-standardization of information, methods, data at diverse sites
6. Patient Safety/Infection Control Initiatives at The Cleveland Clinic Improving influenza vaccinations among health care workers
Improving hand hygiene
Reducing risk of surgical site infections
Efficacy of decolonization of S. aureus nasal carriage prior to open heart surgery
Improving antimicrobial use
Penicillin skin testing
7. Outbreaks of influenza in hospitals have been linked to transmission from otherwise healthy healthcare personnel and are a major patient safety issue.
The Advisory Committee on Immunization Practices (ACIP) recommends that healthcare personnel with patient care duties receive an annual influenza vaccine.
However, vaccination rates among healthcare personnel are extremely poor; less than 40% of personnel are immunized in most facilities.
* One or more high-risk medical conditions including diabetes, current cancer treatment, or chronic heart, lung, or kidney disease.
** Healthcare workers included persons currently employed in healthcare occupations, regardless of setting, and persons currently employed in healthcare settings without a healthcare occupation.
Outbreaks of influenza in hospitals have been linked to transmission from otherwise healthy healthcare personnel and are a major patient safety issue.
The Advisory Committee on Immunization Practices (ACIP) recommends that healthcare personnel with patient care duties receive an annual influenza vaccine.
However, vaccination rates among healthcare personnel are extremely poor; less than 40% of personnel are immunized in most facilities.
* One or more high-risk medical conditions including diabetes, current cancer treatment, or chronic heart, lung, or kidney disease.
** Healthcare workers included persons currently employed in healthcare occupations, regardless of setting, and persons currently employed in healthcare settings without a healthcare occupation.
8. Influenza Vaccination for Healthcare Workers Healthcare worker influenza vaccinations are supported by
National Foundation of Infectious Diseases
CDC Advisory Committee on Immunization Practices (ACIP)
CDC Healthcare Infection Control Practices Advisory Committee (HICPAC)
Healthcare Worker Influenza Vaccination
Improves patient outcome
Decreases worker absenteeism
Is a measurable patient safety indicator
Recommend monitoring and documentation of immunization and declination rates (as of 2006) Numerous bodies strongly support the concept of healthcare workers getting a flu shot.
NFID
ACIP
HICPAC
Healthcare Worker Vaccination is a good thing -
It improves patient outcomes
Decreases sick days for employees
It is also considered a measurable patient safety indicator
It is now recommended by the CDC to monitor immunization and declination rates.Numerous bodies strongly support the concept of healthcare workers getting a flu shot.
NFID
ACIP
HICPAC
Healthcare Worker Vaccination is a good thing -
It improves patient outcomes
Decreases sick days for employees
It is also considered a measurable patient safety indicator
It is now recommended by the CDC to monitor immunization and declination rates.
9. Why Should We Promote Influenza Vaccination for HCWs at the Cleveland Clinic? It is not pleasant to have the flu!
Patient safety issue
Nosocomial influenza (HCW to patient) is a risk that can be militated
Have you washed you hands? And have you had your flu shot?
JCAHO Guidelines
Business model
Reduce illness leave
Avoid presenteeism
Health outcomes research
If model works for CCF has implications for 10 million HCWs nationwide
10. Influenza ImmunizationsCleveland Clinic Employees Flu clinics for all employees
Nursing in-patient units and ambulatory clinics will be providing vaccine to unit/clinic employees in October-November
Family Health Centers will also have vaccine available to patients and HCWs in October
Mandatory participation system via the Intranet
12. Mandatory Participation
13. Mandatory Participation
14. 2007 Employee Influenza Vaccination Program All CCHS hospitals participating
Leadership dashboard showing participation rates in development by Medical Operations
Hope to have ready by start of program October 29
Request leadership encourage participation by all employees
16. Use of the Intranet to Enhance Influenza Vaccination The overall vaccination rate increased from 38% in 2004 to 55% in 2005 (p<0.000001)
17. 2006 Employee Influenza Vaccination Program
18. 2006 Employee Influenza Vaccination ProgramCCHS Employee Participation
19. ProgramsExamples of multidisciplinary collaboration facilitated by QPSI Hand hygiene – First line of defense against hospital acquired infection
Surveillance for multi-drug resistant organisms
IHI Bundles and Catheter related bloodstream infections
Surgical Infection Prevention
Influenza Vaccination Program
20. Challenges for Employee Influenza Vaccination Program Geography
Workplace culture
Barriers to accurate determination of compliance rates
Ability to link processes with outcomes – opportunity to enhance practice
21. Dashboard:Portal for Providers, Payers and PatientsWhat Should Be Provided? Focus on process measurements as well as “rates” and “numbers”
Drill down to variety of levels of specific and sensitive information
Providers could use to assess “real time” quality improvement
Payers could use to assess outcomes
Health care workers could use to assess safety
22. Quality Dashboards
23. Process Improvement and Accountability
24. Infectious diseases specialists are one important resource for providing input, but many other professionals also contribute to optimal care for patients with infections.
Like all patient safety endeavors, multidisciplinary collaboration is key! Infectious diseases specialists are one important resource for providing input, but many other professionals also contribute to optimal care for patients with infections.
Like all patient safety endeavors, multidisciplinary collaboration is key!
25. Acknowledgements Infection Control and Hospital Epidemiology Team
Steven Gordon
Thomas Fraser
Steven Schmitt
Mary Bertin
Cynthia Fatica
Michelle Scarpelli
Joan Kowalczyk
Megan DiGiorgio
Persis Sosiak
Maria Caserta
John Baker
QPSI
Michael Henderson
Jackie Matthews
Nursing Quality
Monica Weber