Washington State Hospital Association Partnership for Patients Safe Table Reducing Hospital Acquired Infections July 31, 2013 Amber Theel, Director Patient Safety Presented at Washington State Hospital Association Safe Table, July 31, 2013

Partnership for Patients 40 – Percent reduction in harm 20 – Percent reduction in readmissions 13 – By December Presented at Washington State Hospital Association Safe Table, July 31, 2013

10 Targeted Strategies Infection Reduction: 1. Catheter-associated urinary tract infections (CAUTI) 2. Central line-associated blood stream infections (CLABSI) 3. Surgical site infections (SSI) 4. Ventilator-associated pneumonia (VAP) Nursing Care: 5. Injuries from falls and immobility 6. Pressure ulcers High Risk: 7. Adverse drug events 8. Obstetrical adverse events 9. Venous thromboembolism or blood clots (VTE) Continuity of Care: 10. Prevention of readmissions 3 Presented at Washington State Hospital Association Safe Table, July 31, 2013

Submission rates for most recent quarter: CLABSI: 84.8% VAP: 92.4% CAUTI: 86.4% SSI: 87.5% Falls: 69.2% Pressure Ulcers: 90.5% EED: 92.1% VTE: 81.1% Readmission: 100.0% ADE: 35.8% Leadership, Patient and Family: 64.2% Goal 40% Goal 20% Below the Line is Better OB CLABSI VAP CAUTI SSI ADE Readmissions Pressure Ulcers Falls 40% 24% 38% 18% 54% 82% 33% Baseline 2010 VTE Based on submitted data through Q for CLABSI and CAUTI Base on submitted data through Q SSI, OB, and Falls Based on submitted data through Q for Readmissions, VTE, and Pressure Ulcers Based on submitted data through March 2013 for ADE 4% Achieve by December 2013 Harm and Readmissions Reduction Results 37% Green – Reached Goal Yellow – Moving in Right Direction Red – Work to be Done 7/9/ % Presented at Washington State Hospital Association Safe Table, July 31, 2013

1.Obstetrical Adverse Events - EED plus Safe Deliveries Roadmap 2.Readmissions - Care transitions standardization 3.CAUTI - Monthly support for hospitals with high rates Dr. Sanjay Saint, Dr. Tim Dellit, and Carol Bradley, RN 4.CLABSI - Action Bundle plus high rate support 5.VAP - Action Bundle plus high rate support 6.SSI - Action Bundle plus glycemic control 7.VTE - Action Bundle 8.Falls - Execution of leading practices 9.Pressure Ulcers - Risk assessment, prevention, early identification and treatment 10.ADE - Action Bundle Global Strategies Monthly reports to hospitals plus transparency Engagement: leadership, patient, and family Culture

Washington State Hospital Association Safety Net Assessment Medicaid Quality Incentive Infection Control Measures 6 Presented at Washington State Hospital Association Safe Table, July 31, 2013

Washington State Hospital Association Selected Measures: Acute, Rehabilitation, and Pediatric Services Infection Prevention Improvement Measure - Catheter-Associated Urinary Tract Infections Per Patient Day (Hospital-wide) Sustaining Measure -Health Care Personnel (HCP) Influenza Vaccination Presented at Washington State Hospital Association Safe Table, July 31, 2013

Presented at Washington State Hospital Association Safe Table, January 31,

Denominator categories: All employee HCP: Includes both full-time and part-time HCP employees Non-employee HCP: Licensed independent practitioners (physicians, advance practice nurses, and physician assistants) Non-employee HCP: Adult students/trainees and volunteers Numerator categories: Influenza vaccinations Medical contraindications Vaccinations outside facility Declinations Unknown status *Facilities are required to report all numerator categories for the three denominator categories Flu Immunization Required Reporting Presented at Washington State Hospital Association Safe Table, January 31, HCP Influenza Vaccination Rates 87.58%

Visitor Restrictions During Flu Season Special restrictions or screening during respiratory/flu season in high risk populations? OB, Women and Newborn, NICU and pediatric facilities. How often are facilities screening visitors for illnesses? How do you identify when patients have been screened? Criteria for restrictions? Age, relationship to patient?

State Reporting Hospital Acquired Infection MeasuresOld State LawNew State LawCMS Central line-associated bloodstream infections (CLABSI) YES (ICU only) YES (All inpatient areas) YES (ICU only) Ventilator-associated pneumonia (VAP)YESNO Deep sternal wound for cardiac surgical site infections YES (until 2017) NO Total hip replacement surgical site infectionsYES (until 2017) NO Total knee replacement surgical site infectionsYES (until 2017) NO Vaginal hysterectomy surgical site infectionsYESNO Abdominal hysterectomy surgical site infectionsYES Colon surgical site infectionsNOYES Presented at Washington State Hospital Association Safe Table, July 31, 2013

Ventilator Associated Pneumonia (VAP) 250,000 VAP in 2002 – 36,000 associated with death VAP reported in NHSN in 2011 Rates varied by type of unit 0.0 to 4.9 per 1000 ventilator days. Presented at Washington State Hospital Association Safe Table, July 31, 2013 How will your facility measure VAP?

MDRO - Challenges  States, Federal, consumer groups, etc., displaying disparate public HAI metrics and formats  Inter-facility communication not standardized for multidrug-resistant organisms (MDRO) & HAI history  Practices across labs not standardized  C. difficile infection (CDI) poorly understood, requiring uniform surveillance  MRSA infection high burden, high morbidity  Rise in MDROs, lack of standardized surveillance of antimicrobial usage Presented at Washington State Hospital Association Safe Table, July 31,

Questions? 10 Presented at Washington State Hospital Association Safe Table, July 31, 2013