INFECTION PREVENTION
Infection prevention efforts continue to focus on HAI prevention.
Reducing the incidence of Central Line-Associated Bloodstream
Infections (CLABSI):
The revised Vascular Access Standard was fully implemented hospital-
wide, and all providers were educated regarding the revisions.
Infection Prevention partnered with clinical experts to assess bedside
central venous line (CVL) care and maintenance practices. Results
of the assessment were reviewed with Nursing. In addition, Infection
Prevention and Nursing collaborated with resource utilization to refine
CVL care supplies. Infection Prevention and Nursing also conducted
rounds on patients with a CVL to assess care and maintenance. Details
of all CLABSI events were immediately reported to the health care
team, and reviews of each case were conducted using a standardized
review process. Results from case reviews were shared monthly with
Nursing. To maintain focus on CLABSI prevention strategies, Infection
Prevention reported CLABSI data daily in bed huddles and weekly in a
summary report. CLABSI data were reported and reviewed monthly at
the Health System Infection Prevention Committee and at the Nursing
Quality Council Infection Prevention Subgroup.
There were 94 CLABSI events for FY17, which met our goal of fewer
than 100 CLABSI events for the fiscal year.
Reducing the incidence of Methicillin-Resistant Staphylococcus
Aureus (MRSA):
Efforts to reduce CLABSI also resulted in a decrease in MRSA
bloodstream LabID events. There were 40 such events during FY17, a
decrease from 64 events during FY16, which met our goal of fewer than
50 events for the fiscal year.
Reducing the incidence of Catheter-Associated Urinary Tract
Infections (CAUTI):
Regarding catheter-associated urinary tract infections (CAUTI), details
of newly identified CAUTI events were immediately reported to the
health care team. An assessment of urinary catheter insertion and
maintenance was conducted on CMS-reportable locations. Results
were reported to Nursing. In addition, Infection Prevention and Nursing
conducted rounds on patients with a urinary catheter to assess care
and maintenance. To maintain focus on CAUTI prevention strategies,
Infection Prevention reported CAUTI data weekly in a summary report.
CAUTI data was reported and reviewed monthly by the Health System
Infection Prevention Committee and the Nursing Quality Council
Infection Prevention Subgroup.
The infection prevention team implemented electronic surveillance
through Cerner IC Solutions in January 2017. Use of this tool
consolidated all of the information needed for health care-associated
infection (HAI) surveillance into one source, enabling the infection
prevention specialists to be more efficient in their work.
However, there were 64 CAUTI events during FY17, so the goal of fewer
than 60 events was not met.
Reducing the incidence of C. difficile:
Prevention of hospital-onset clostridium difficile infection (CDI) also
was a focus of the infection prevention team during FY17. Interventions
included alerts that go out to the providers when CDI lab testing was
ordered if the patient was prescribed a laxative in the prior 48 hours.
Details of newly identified CDI events were shared with the health
care team, including a review of event details with emphasis on key
components of the CDI prevention bundle (laxative administration, fever,
white blood count, diarrhea, and CDI treatment). CDI data is reported
and reviewed quarterly at the Health System Infection Prevention
Committee and at the Nursing Quality Council Infection Prevention
Subgroup. Although the goal of fewer than 150 CDI events was not met
in FY17, the total of 153 CDI events was significantly lower than the
200+ events that occurred in FY16.
Interventions to prevent HAI planned by the infection prevention team
during the coming year include:
• Enhanced rounding to assess care and maintenance of central
venous lines and urinary catheters
• Reinforcement of the urinary retention and nurse-driven urinary
catheter removal protocols, in order to decrease urinary catheter days
• Rounding to assess compliance with environmental infection
prevention best practices
• Continued analysis and feedback of HAI event details to the health
care team
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