1 / 17

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. FY 2003 Traditional Approach. FY 2004 PPC Approach. ICU Admissions (n). 1753 ASG: 2.1. 1798 ASG: 2.3. Patients with CLABs (n).

EllenMixel
Download Presentation

Eliminating Hospital Acquired Infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Eliminating Hospital Acquired Infections Is it Possible?Is it Sustainable?Is it Worth It? CCU / MICU Department of Medicine Allegheny General Hospital

  2. 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

  3. 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

  4. What Happened?? FY05 FY04 Education Standardization

  5. 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

  6. 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)

  7. 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

  8. The Results with VAP (46) (45) (8) VAP Bundle

  9. 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

  10. 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)

  11. 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)

  12. The Incentives Are Not Aligned with Outcomes $6,938 $3,292 $8,426 $24,435

  13. 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

  14. Savings Are Likely to Far Exceedthe Costs of Intervention

  15. 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

  16. 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)

  17. 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

More Related