In compliance with healthcare-associated infection reporting requirements by the Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Prospective Payment System, CMS made hospital-specific central line-associated bloodstream infection (CLABSI) data for first quarter of 2011 available to the public on its Hospital Compare website. The information, which is currently available for hospital preview, will is now posted to Hospital Compare

A new report by the Health Technology Safety Research Team (HTSRT) at the University of Toronto provides nine specific recommendations to reduce the risks of hospital infection associated with multiple intravenous (IV) infusions. The report stems from twelve field studies in Ontario hospitals, carried out in conjunction with the Institute for Safe Medication Practices, Canada. The report, “Mitigating the Risks Associated with Multiple IV Infusion,” was released at a recent meeting of the AAMI Healthcare Technology Safety Institute (HTSI) and calls for the immediate adoption of these recommendations by healthcare institutions for hospital infection prevention.

Multiple IV infusions are often delivered with large volume pumps “through a combination of primary and secondary ‘piggyback’ infusions on multiple pumps and channels,” according to the HTSRT website, making the system prone to a variety of errors, including mix-ups of infusion lines, bags, and pumps.

The HTSRT study conducted fieldwork and experimental research to assess these risks. The report delineates nine recommendations to improve safety in specific areas, including secondary infusions, line identification, line set-up and removal, and IV bolus administration. The HTSRT report provides detailed rationale for each of these recommendations, as well as photographs and diagrams to guide healthcare workers in areas where multiple IV infusions are administered to patients, such as intensive care units, outpatient chemotherapy clinics, and hospital emergency departments.

Link: Visit AAMI for the report.

February 2, 2012

A majority of nurses spend about one-quarter of a 12-hour shift on activities that do not require direct interaction with patients—an increase over years prior, according to a recent survey.

For the survey, Jackson Healthcare polled 420 nurses between July and November 2011. The findings also showed that about 78% of nurses reported spending at least two hours per shift on indirect patient care, up from 73% in 2009.

According to the survey, the most frequently listed indirect patient care activities were:

• Documenting information in multiple locations;
• Completing logs, checklists, and collecting data;
• Traveling to equipment, supply, and utility rooms; and
• Entering and reviewing orders.

Link:
Glenn, MedCity News, 1/31
Jackson Healthcare release, 1/30

Milwaukee Journal Sentinel – January 29, 2012

The Milwaukee Journal Sentinel reported that roughly one in 20 patients acquires an infection while hospitalized. These infections can come from ventilators; central lines used to deliver fluids, medication and blood; urinary catheters; or surgical sites.

The Wisconsin Hospital Association has launched a statewide initiative, funded with money included in the federal health care reform law, to reduce hospitalacquired infections, conditions and readmissions. Roughly 100 hospitals plan to participate in the initiative. They include hospitals operated by Aurora Health Care, Froedtert Health, ProHealth Care and Wheaton Franciscan Healthcare. The initiative is part of a national project announced last year by Health and Human Services Secretary Kathleen Sebelius to reduce hospital-acquired conditions by 40% and hospital readmissions by 20% by the end of 2013. Specifically, the association’s Partners for Patients Initiative will build on an earlier project to reduce bloodstream infection from central lines. That initiative – combined with other work – resulted in some hospitals not having a central-line infection for more than a year. Aurora Sinai Medical Center, for example, then went 500 days without a central-line infection in its intensive care unit and now has gone 190 days without one.

Link: http://www.jsonline.com/business/state-hospitals-try-to-do-no-harm-lr3tqbl-138279549.html

Pediatric ICUs report 20% more central-line associated bloodstream infections (CLABSIs) than their adult counterparts, according to a report from the Consumer Reports Health Ratings Center.

Using state reports and data provided by Leapfrog, Consumer Reports researchers assessed 2010 bloodstream infection rates at 92 pediatric ICUs across 31 states and the District of Columbia. They rated each pediatric ICU based on its CLABSI rate. The full list is available here.

Overall, Consumer Reports researchers found that pediatric ICUs average 1.8 CLABSIs per 1,000 central line days. In comparison, national data in 2009 showed that adult ICUs averaged 1.5 CLABSIs per 1,000 central line days.

Only five pediatric ICUs included in the report reported zero CLABSIs in 2010, earning them Consumer Reports’ top pediatric ICU infection rating. Those ICUs were:

• Children’s Hospitals and Clinics of Minnesota and St. Paul;
• Medical University of South Carolina (Charleston);
• Robert Wood Johnson University Hospital (New Brunswick, N.J.);
• Tulane Medical Center (New Orleans); and
• University Medical Center (Las Vegas).

Meanwhile, 26 of the facilities received poor infection ratings. In fact, some pediatric ICUs reported as many as 7.2 CLABSIs per 1,000 central line days, four times more than the national average for adult ICUs.

CDC data shows that 12,000 to 28,000 CLABSIs occurred in ICUs in 2009. About 25% of those cases were fatal. More than half of the country’s 400 pediatric ICUs do not make their infection data publicly available.

Links:
McCarthy, Consumer Reports News, 1/26
Consumer Reports report, January 2012
Carollo, ABC News, 1/26.

The Joint Commission targets central line-associated bloodstream infections in its 2011 national patient safety goals, with NPSG.07.04.01 calling for hospitals to “implement evidence-based practices to prevent (CLABSIs).”

Specifically, the goal targets hand hygiene, multidrug-resistant organisms, central line-associated bloodstream infections and surgical site infections. The Joint Commission requires whole-house surveillance on this issue including every patient who has a central line—not just those in the ICU.

For more information: http://www.jointcommission.org/assets/1/6/2011_NPSGs_HAP.pdf

An article by investigators in St. Louis, Missouri provides national estimates of the number of CLABSIs among patients in ICUs, inpatient wards, and outpatient hemodialysis facilities in 2008 and 2009 and compares ICU estimates with 2001 data. In 2001, an estimated 43,000 CLABSIs occurred among patients hospitalized in ICUs in the United States. In 2009, the estimated number of ICU CLABSIs had decreased to 18,000. In 2009, an estimated 23,000 CLABSIs occurred among patients in inpatient wards, and in 2008, an estimated 37,000 CLABSIs occurred among patients receiving outpatient hemodialysis. In 2009 alone, an estimated 25,000 fewer CLABSIs occurred in US ICUs than in 2001, a 58% reduction. This represents up to 6,000 lives saved and $414 million in potential excess health care costs in 2009 and approximately $1.8 billion in cumulative excess health care costs since 2001.

The researchers concluded that although major reductions have occurred in the burden of CLABSIs in ICUs at the mandate of State and federal efforts, a substantial number of hospital infections occurring in non-ICU settings, especially in outpatient hemodialysis centers reveals and important area for expanded prevention efforts.  “To prevent CLABSIs in hemodialysis patients, efforts to reduce central line use for hemodialysis and improve the maintenance of central lines should be expanded,” wrote S.Y. Liang and colleagues, Washington University.

Citation: Update on Emerging Infections: News From the Centers for Disease Control and Prevention. Annals of Emergency Medicine, 2011;58(5):447-450).

Source: Managed Care Weekly Digest, December 12, 2011

A recently published paper on a Department of Veteran’s Affairs (VA) project on CLABSI reduction used the requisite bundles, but focused on education and spreading the word in a manner appropriate to each VA facility (Render, Hasselbeck, Freyberg. BMJ Qual Saf 2011: 20:725-732.) The result was a decline from 3.8 CLABSI infections per 1,000 line days to 1.8 per 1,000 line days.

Marta Render, MD, one of the researchers on the project, said the focus had to be on learning because the VA is a “gargantuan system. We had to think about how to get learning out to people who needed it. We did not want to have to push this out to everyone, but have them pull it in.” To spread the knowledge, they developed web-based tools and kits, including the critical development of the daily goal sheet. “It is a great tool that changed the way we work together,” Render says.

Once implemented and data collection started, Render and the team worked with outliers, conducting structured interviews and setting achievable goals – find a team leader in the next week, check the data the next day. Then the team would follow up on those goals, finding out what went wrong if the goal was not achieved and suggesting potential solutions.

The results were initially rolled out in ICUs, but have since been spread to other inpatient units and VA community living centers. CAUTI and ventilator-associated pneumonia are next on the list.

Source: Hospital Employee Health; November 1, 2011

CQ TODAY ONLINE NEWS
Oct. 28, 2011 – 7:55 p.m.

Lawmakers are pushing the Veterans Affairs Department’s health care system to pave the way for the use of new medical devices to help hospitals nationwide prevent infections, which drive health costs up by $34 billion a year. Reps. Ann Marie Buerkle, R-N.Y., who is a nurse, and Michael H. Michaud, D-Maine, want the VA’s medical centers to expand their already effective, if largely low-tech, procedures and employ new technologies that can help eradicate dangerous bacteria such as methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile, which can eat flesh, destroy colons and kill people.

Buerkle, the chairwoman of the Veterans Affairs Health Subcommittee, hosted a congressional roundtable on Oct. 25 to review the latest innovations available to reduce hospital infections. “The VA has infrastructure and resources to become a national leader,” Buerkle said. “But in order to do so it must leverage the very best ideas, practices, procedures and products.”

Although many new devices can be costly, some simpler products also were on display, such as small green caps filled with alcohol that attach to medicine ports on IV tubing. The caps are sold by Ivera Medical and intended to reduce bloodstream infections linked to IV use. Nurses are supposed to scrub IV ports but often do not and this leads to costly and dangerous central line bloodstream infections.

Buerkle said information available on technological devices that can lower infection rates and improve care is not making its way through the VA system. “They’ve got to communicate, they’ve got to make sure that all their facilities have this information,” she said. “And if then they identify a technology that the evidence shows is worth having, that they present it as a national contract versus just one hospital.”

With VA officials facing greater pressure to use innovative systems throughout their facilities, the lack of data on the effectiveness of such devices could, however, make it hard to fulfill the pacesetter role.

Link to Full article: http://public.cq.com/docs/news/news-000003971757.html

Each year more than one million patients receive cancer treatment in an outpatient oncology clinic. Despite advances in oncology care, infections from both community and health care settings remain a major cause of hospitalization and death among cancer patients receiving chemotherapy. To help protect this vulnerable patient population, the Centers for Disease Control and Prevention is launching a new program featuring tools to help both clinicians and patients prevent infections and hospital infections.

CDC’s Preventing Infections in Cancer Patients program is a comprehensive initiative focusing on providing information, action steps, and tools for patients, their families, and their health care providers to reduce the risk of life-threatening infections during chemotherapy treatment. These resources include an interactive website (http://www.preventcancerinfections.org) for cancer patients and caregivers, as well as a Basic Infection Control and Prevention Plan for use by outpatient oncology settings.

Preventing Infections in Cancer Patients was developed by oncology and infection prevention experts from CDC in partnership with external experts and the CDC Foundation.

SOURCE:  Oct. 25, 2011 PRNewswire-USNewswire