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Eliminating Hospital Acquired Infections. Is it Possible? Is it Sustainable? Is it Worth It?. CCU / MICU Department of Medicine Allegheny General Hospital. FY 2003 Traditional Approach. FY 2004 PPC Approach. ICU Admissions (n). 1753 ASG: 2.1. 1798 ASG: 2.3. Patients with CLABs (n).

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eliminating hospital acquired infections

Eliminating Hospital Acquired Infections

Is it Possible?Is it Sustainable?Is it Worth It?

CCU / MICU

Department of Medicine

Allegheny General Hospital

slide2

FY 2003

Traditional Approach

FY 2004

PPC Approach

ICU Admissions (n)

1753 ASG: 2.1

1798 ASG: 2.3

Patientswith CLABs (n)

37

6

Age (years)

62 (24-80)

62 (50-74)

Gender (male/female)

22/15

3/3

TotalCLABS

49

6

Lines

1063

1110

Linedays

4683

5052

10.5

1.2

Deaths in patients with CLABs

19 (51%)

1 (16%)

ComparativeResults

Overallrates

(infections /1000 line days)

Risk of CLAB

1 in 22

1 in 185

slide3

FY 2004

PPC Approach

FY 2005

PPC Approach

ICU Admissions (n)

1798 ASG:2.3

1879 ASG:2.5

Patientswith CLABs (n)

6

11

Age (years)

62 (50-74)

65 (39-71)

Gender (male/female)

3/3

5/6

TotalCLABS

6

11

Lines

1110

1321

Linedays

5052

6505

1.2

1.5

Deaths in patients with CLABs

1 (16%)

1 (9%)

Are the Results Sustainable ?

Overallrates

(infections /1000 line days)

Risk of CLAB

1 in 185

1 in 120

slide4

What Happened??

FY05

FY04

Education

Standardization

why did we slip
Why Did We Slip?
  • 70% of the CLABs in FY05 were related to line placement issues
  • We had not developed training for line placement
  • Residents and fellows are masters of the “work around”
  • We are using more and more PICC without proper technique and training
central line training module workers have to be given the training necessary to be successful
Central Line Training ModuleWorkers have to be given the training necessary to be successful
  • 1 hour didactic with test
  • “The Perfect Line Placement ” Video
  • Two Hours in the “Line training Simulator”
  • Inter disciplinary (residents/fellows/nurses)
eliminating vap
Eliminating VAP
  • July2004:

We implemented real time problem solving around every VAP case

  • October, 2004:

We implemented countermeasures developed by the people doing the work (AGH VAP Bundle)

  • July, 2005:

We assessed improvement compared to data from the previous 2 years

the results with vap
The Results with VAP

(46)

(45)

(8)

VAP Bundle

eliminating vap how did we do it
Eliminating VAP:How Did We Do It?
  • Step 1: Elevate the head of the Bed 30
  • Step 2: Chlorhexidine mouthwash BID
  • Step 3: Change vent tubing daily
  • Step 4: Change suction catheter daily
  • Step 5: provide a hook for hanging resuscitation bag

Total Added Cost: $17/ intubated patient

the financial losses due to vap are sizable
The Financial Losses due to VAP Are Sizable

(*Excluded from the data are 57 non-VAP cases in fiscal year 04/05 due to the lack of reimbursement data on these cases)

slide11

Best Clinical Outcome Does Not Reward AGH

VAP vs. Non-VAP Separated into Clinical Outcomes

(*Excluded from the data are 57 non-VAP cases in fiscal year 04/05 due to the lack of reimbursement data on these cases)

step 7 estimate the cost of the intervention
Step 7 :Estimate the Cost of the Intervention
  • Variable costs of the actual components

$ 0.4 / day (chlorohexidine mouthwash)

+$ 1.0 / day (clear and blue ventilator tubes)

= $ 1.4 / day

*11.17 (average days on ventilator)

= $15.64 / patient

+ $ 0.58 / patient (Yankauer suction)

+ $ 0.75 / patient (resuscitation bag hook)

= $17 (per patient)

  • No other costs associated with implementation

- no special training for nurses

- little additional time for nurses to perform

ccu micu and hai a big return on investment
CCU/MICU and HAIA Big Return on Investment
  • Total Savings

CLAB= $1,235,765

VAP= $1,003,162

  • Highmark PFP = $2,100,000
  • HAI elimination Initiatives = +$4,338,927
  • Investment = $34,927
ccu micu and hai the benefits are no longer theoretical
CCU/MICU and HAIThe Benefits are no Longer Theoretical
  • AGH has returned $1.5 million of the saving to further HAI elimination
  • $400,000 to hire 8 respiratory therapists
  • $350,000 for CLAB training module
  • The CCU/MICU experience needs to be confirmed (PHC4/JHF collaborative)
summary
Summary
  • Progress but by no means excellence
  • Each class of HAI represent a enormous clinical and economic opportunity
  • Training, commitment, and collaboration

(not policies and guidelines) are needed.

  • Excuses are no longer acceptable
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