1 © 2010 TMIT NQF-Endorsed ® Safe Practices for Better Healthcare Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections

© 2006 HCC, Inc. CD XX 2 © 2010 TMIT Slide Deck Overview Slide Set Includes:  Section 1: NQF-Endorsed ® Safe Practices for Better Healthcare Overview  Section 2: Harmonization Partners  Section 3:The Problem  Section 4: Practice Specifications  Section 5: Example Implementation Approaches  Section 6: Front-line Resources

3 © 2010 TMIT Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections NQF-Endorsed ® Safe Practices for Better Healthcare Overview

4 © 2010 TMIT 2010 NQF Safe Practices for Better Healthcare: A Consensus Report 34 Safe Practices Criteria for Inclusion Specificity Benefit Evidence of Effectiveness Generalization Readiness

5 © 2010 TMIT Culture SP NQF Report

CHAPTER 7: Healthcare-Associated Infections Hand Hygiene Influenza Prevention Central Line-Associated Blood Stream Infection Prevention Surgical-Site Infection Prevention Daily Care of the Ventilated Patient MDRO Prevention Catheter-Associated UTI Prevention Information Management and Continuity of Care Medication Management Healthcare-Associated Infections Condition- and Site-Specific Practices Consent & Disclosure Wrong-site Sx Prevention Press. Ulcer Prevention VTE Prevention Anticoag. Therapy VAP Prevention Central Line-Assoc. BSI Prevention Sx-Site Inf. Prevention Contrast Media Use Hand Hygiene Influenza Prevention Pharmacist Leadership Structures and Systems Med. Recon. Culture CPOE Read-Back & Abbrev. Discharge Systems Patient Care Info. Labeling Diag. Studies Culture Meas., FB., and Interv. Structures and Systems Risk and Hazards Team Training and Skill Bldg. Nursing Workforce ICU Care Direct Caregivers Workforce CHAPTER 4: Workforce Nursing Workforce Direct Caregivers ICU Care CHAPTER 2: Creating and Sustaining a Culture of Safety (Separated into Practices]  Culture of Safety Leadership Structures and Systems  Culture Measurement, Feedback, and Intervention  Teamwork Training and Skill Building  Risks and Hazards CHAPTER 5: Information Management and Continuity of Care  Patient Care Information  Order Read-Back and Abbreviations  Labeling Diagnostic Studies  Discharge Systems  Safe Adoption of Computerized Prescriber Order Entry CHAPTER 6: Medication Management  Medication Reconciliation  Pharmacist Leadership Structures and Systems CHAPTER 8: Condition- and Site-Specific Practices Wrong-Site, Wrong-Procedure, Wrong-Person Surgery Prevention Pressure Ulcer Prevention VTE Prevention Anticoagulation Therapy Contrast Media-Induced Renal Failure Prevention Organ Donation Glycemic Control Falls Prevention Pediatric Imaging Informed Consent Life-Sustaining Treatment Disclosure CHAPTER 3: Consent and Disclosure Informed Consent Life-Sustaining Treatment Disclosure Care of the Caregiver Consent and Disclosure Care of Caregiver MDRO Prevention UTI Prevention Falls Prevention Organ Donation Glycemic Control Pediatric Imaging

7 © 2010 TMIT Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections Harmonization Partners

8 © 2010 TMIT Harmonization – The Quality Choir

9 © 2010 TMIT The Patient – Our Conductor

© 2006 HCC, Inc. CD XX 10 © 2010 TMIT The Objective Multidrug-Resistant Organism Prevention  Prevent healthcare-associated multidrug-resistant organism (MDRO) infections, including methicillin- resistant Staphylococcus aureus (S. aureus) (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile infections (CDIs)

11 © 2010 TMIT The Problem Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections

© 2006 HCC, Inc. CD XX 12 © 2010 TMIT The Problem

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© 2006 HCC, Inc. CD XX 16 © 2010 TMIT The Problem Frequency  MRSA accounts for more than 50% of hospital- acquired S. aureus infections  82% of hospitals have not seen CDI rates decrease in the past 3 years  Doubling of hospital discharges with CDIs from 2001 to 2005  Increase to more than 300,000 CDI cases in 2005 [NNIS, Am J Infect Control 2004 Dec;32(8):470-85; Jarvis, Am J Infect Control 2009 May;37(4):263-70; Carrico, Guide to the Elimination of Clostridium difficile in Healthcare Settings, 2008]

© 2006 HCC, Inc. CD XX 17 © 2010 TMIT The Problem Severity  More than 5,000 deaths each year are attributable to MRSA  Attributable mortality rate of 6.9% at 30 days and 16.7% at 1 year [Institute for Healthcare Improvement, 5 Million Lives Campaign, 2008; Levinson, Adverse events in hospitals: state reporting systems, 2008; Loo, N Engl J Med 2005 Dec 8;353(23):2442-9; Muto, Infect Control Hosp Epidemiol 2005 Mar;26(3):273-80; Pépin, Clin Infect Dis 2005 Nov 1;41(9): ]

© 2006 HCC, Inc. CD XX 18 © 2010 TMIT The Problem Preventability  40% reduction in MDROs by implementing a checklist for hospital interventions  A notification system should be established in a timely manner  The decrease in MDROs will also lead to a decline in other infections [Siegel, Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006; Siegel, Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings, 2007; Abbett, Infect Control Hosp Epidemiol 2009 Nov; 30(11):1062-9; Dubberke, Infect Control Hosp Epidemiol 2009 Jun;30(6):518-25; O’Dowd, BMJ 2009 Jun 26;338:b2580]

© 2006 HCC, Inc. CD XX 19 © 2010 TMIT The Problem Cost Impact  Additional cost of $39K per case in patients with a MRSA surgical-site infection  Mortality rates were 13% higher in patients with MRSA infection  Hospital costs due to CDI range from $6.4K to $9.1K in 2007 dollars [Engemann, Clin Infect Dis 2003 Mar 1;36(5):592-8; Scott, The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2009]

20 © 2010 TMIT Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections Practice Specifications

© 2006 HCC, Inc. CD XX 21 © 2010 TMIT Additional Specifications

© 2006 HCC, Inc. CD XX 22 © 2010 TMIT Safe Practice Statement Multidrug-Resistant Organism Prevention  Implement a systematic multidrug-resistant organism (MDRO) eradication program built upon the fundamental elements of infection control, an evidence-based approach, assurance of the hospital staff and independent practitioner readiness, and a re-engineered identification and care process for those patients with or at risk for MDRO infections

© 2006 HCC, Inc. CD XX 23 © 2010 TMIT Additional Specifications  The organization’s leadership has assigned responsibility of the development, testing, and implementation of an MDRO prevention program  Conduct a risk assessment for MDRO acquisition and transmission  Educate staff and licensed independent practitioners about MDROs, including risk factors, routes of transmission, outcomes associated with infection, prevention measures, and local epidemiology [Siegel, Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006; Calfee, Infect Control Hosp Epidemiol Oct;29 Suppl 1:S62-80; Dubberke, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S81-92; Joint Commission Resources, National Patient Safety Goal NPSG , 2010; Institute for Healthcare Improvement, Infection Prevention, IHI Improvement Map, 2009; Seto, J Hosp Infect 1995 Jun;30 Suppl:241-7; TMIT, MRSA: For the Birds, or Pandemic Potential?, 2008]

© 2006 HCC, Inc. CD XX 24 © 2010 TMIT Additional Specifications  Educate patients colonized with MRSA and their families about healthcare-associated infections and infection prevention strategies  Implement a surveillance program for MDROs based on risk assessment  Measure and monitor MDRO prevention processes and outcomes  Provide MDRO surveillance data, prevention processes, and outcome measures to key stakeholders [Lewis, J Hosp Infect 1999 Sep;43(1):19-23; NHSN, Multidrug-resistant Organism and Clostridium difficile-Associated Disease Module, 2009 ; Calfee, Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S62-80]

© 2006 HCC, Inc. CD XX 25 © 2010 TMIT Additional Specifications  Implement a system to provide immediate notification about newly diagnosed MDRO- colonized or -infected patients  Implement an alert system that identifies readmitted or transferred MRSA-colonized or -infected patients  Promote compliance with hand hygiene recommendations  Use contact precautions for MDRO-colonized or - infected patients  Ensure cleaning and disinfection of equipment and environment [Boyce, Infect Control Hosp Epidemiol 2009 Jun;30(6):515-7; Johnson, Med J Aust 2005 Nov 21;183(10):509-14; Centers for Disease Control and Prevention, Preventing Transmission of Infectious Agents in Healthcare Settings, 2007; D’Agata, Clin Infect Dis 2009 Feb 1;48(3):274-84; Institute for Healthcare Improvement, Standard Precautions: IHI Improvement Map, 2009; Lederer, Jt Comm J Qual Patient Saf 2009 Apr;35(4):180-5; Salgado, Am J Infect Control 2009 Feb 23]

26 © 2010 TMIT Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections Example Implementation Approaches

© 2006 HCC, Inc. CD XX 27 © 2010 TMIT Example Implementation Approaches

© 2006 HCC, Inc. CD XX 28 © 2010 TMIT Example Implementation Approaches  Place patients with MDRO on contact precautions to reduce patient-to-patient spread of the organism within the hospital  Ensure cleaning and disinfection of equipment and the environment  Implement an MRSA active surveillance program  Initiate an antimicrobial stewardship program [Calfee, Infect Control Hosp Epidemiol Oct;29 Suppl 1:S62-80; Agency for Healthcare Research and Quality, National Healthcare Quality Report 2008, 2009; Institute for Healthcare Improvement, Antibiotic Stewardship, IHI Improvement Map, 2009; Weber, What Every Health Care Executive Should Know: The Cost of Antibiotic Resistance, 2009]

© 2006 HCC, Inc. CD XX 29 © 2010 TMIT Example Implementation Approaches Strategies of Progressive Organizations  Readiness of hospital staff and independent practitioners:  For program success, there must be a culture change  Accountability of leaders and their staff is absolutely necessary in order to decrease MDRO infections and prevent needless morbidity and mortality  Hospital leadership performs tracers [Humphreys, Clin Microbiol Infect 2009 Feb;15(2):120-4; Mears, J Hosp Infect 2009 Apr;71(4):307-13]

30 © 2010 TMIT Safe Practice 24 Multidrug-Resistant Organism Prevention Chapter 7: Improving Patient Safety Through the Prevention of Healthcare-Associated Infections Front-line Resources

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© 2006 HCC, Inc. CD XX 37 © 2010 TMIT TMIT National Webinar Series Healthcare-Associated Infection and You: Cleaner, Safer Care (Safe Practices 19-25)  Kathy Warye – Topic: Perspective on the Development of the Implementation Examples of the NQF Safe Practices  Peter Angood, MD – Topic: HAI National Attention and Harmonization  David Classen, MD – Topic: HAI Compendium Harmonization with the Safe Practices  Julianne Morath, RN – Topic: Implementation  Jennifer Dingman – Topic: Call to Action  Go to: (May 14, 2009)

© 2006 HCC, Inc. CD XX 38 © 2010 TMIT TMIT National Webinar Series MRSA: For the Birds, or Pandemic Potential? (Safe Practice 22)  Cheryl Ann Creen, RN, MSN – MRSA Prevention Coordinator, VA Pittsburgh Healthcare  Candace Cunningham, RN – MRSA Prevention Coordinator, Acute Care, VA Pittsburgh Healthcare System  Jan Englebright, PhD, RN – Chief Nursing Officer, HCA  Jason Hickok, MBA, RN – Director, Critical Care & Infection Prevention, Clinical Services Group, HCA  Jonathan Perlin, MD – Chief Medical Officer, HCA  Go to: (April 8, 2008)