Issues, trends, and resources for combating the problem. Nancy Hudecek RN, BSN, MS Director, Risk Management, Patient Safety, and Quality Improvement Today’s webinar will begin promptly at 2:00 PM Central Time The dial in number is and the code is # To mute your phone line and eliminate background noise, press *6 To unmute and ask questions, press #6, or use the Q&A button

1.7 Million Cases and 99,000 deaths annually  32 percent are urinary tract infections  22 percent are surgical site infections  15 percent are pneumonia (lung infections)  14 percent are bloodstream infections

 Catheter-Associated Urinary Tract Infection  Comprise 32% of all HAIs; average cost is $3,200  Duration is most important patient risk (3-7% per day)  26% of patients cathed 2-10 days develop bacteriuria  24% of patients with bacteriuria will develop CAUTI  3% of patients with CAUTI will develop bacteremia  Most infections are asymptomatic  Staff must understand caregiver risk factors

 Surgical Site Infections comprise 22% of all HAIs  Develop within 30 days of operation (1 year w/implant)  Up to 5% of surgical patients; average cost is $25,000  SSI HAIs on Hospital Acquired Conditions “List” ◦ Mediastinitis following CABG ◦ SSI following Bariatric Surgery including Laparoscopic Gastric Bypass or Restrictive Surgery and Gastroenterostomy ◦ SSI following Orthopedic Procedures of Spine, Neck, Shoulder and Elbow  Staff must understand caregiver risk factors

 Pneumonia comprises 15% of all HAIs and  Ventilator-Associated Pneumonia increases risk 6-21%  VAP occurs in 8-28% of MV patients; cost $49,000  Usually occurs within 4 days of intubation  Overall rate 1-4 cases per 1,000 ventilator days  Rate varies by hospital area, highest in burn, trauma, neuro/neurosurgical and surgical care patients  Most commonly caused by S Aureus and Pseudomonas  Staff must understand risk factors

 Catheter-Related Bloodstream Infections  Comprise 14% of HAIs and cost $34,500-$56,000  CRBSI rates vary depending on the type of catheter used and the patient's underlying condition.  CVC BSI rate 5.3 per 1000 catheter days in the ICU  Common pathogens are staph and enterococcus  Staff education makes a difference in prevention

 Human Impact  Direct medical costs range from $35.7 to $45 billion  Hospital-Acquired Conditions (HAC) and Present on Admission (POA) Indicator Reporting  Inpatient Prospective Payment System (IPPS)  “Quality adjustment” to hospital payments  No additional pay for HACs and HAIs

“Superbugs”

Methicillin-resistant Staphylococcus aureus

Frequency, Severity and Mortality

Bacilli on the left, colonies on the right

PreventionEducationSurveillance

 Elimination of Catheter-Associated Urinary Tract Infections in Hospital Settings  Elimination of Surgical Site Infections in Hospital Settings  Elimination of Ventilator-Associated Pneumonia in Hospital Settings  Elimination of CR-BSI in Hospital Settings  Elimination of MRSA in Hospital Settings  Elimination of C. difficile in Hospital Settings