1. What are the top Healthcare Associated Infections (HAI) and how can patients/consumers avoid contracting them? Ashley Tait-Dinger, MBA Director, Quality & Value Measurement June 20, 2016

2. A statewide, 501(c)(3) non-profit employer coalition on health, established 32 years ago by large employers to improve community health through research, education and community health improvement efforts.

3. community catalyst FLHCC is a community catalyst that uses its collective employer power to effect change in health care delivery. voice of employers FLHCC is the voice of employers on health care cost and quality issues. work collaboratively We strive to work collaboratively with our community partners to improve the quality of health care in Florida and to make health care affordable and sustainable.

4. All FLHCC Members and Partners Updated: 05/6/2016

5. Why We Do What We Do Clinical Quality of Care + Patient Experience = Cost Effectiveness Make Quality Transparent High-value health care is a must!

6. Topics for today What are the top infections acquired in the healthcare environment? How do you contract them? What can patients / consumers do to prevent them? What is the hospital safety score and how infections are included? What tools or resources are available to consumers/patients on staying safe in a hospital?

7. Healthcare-Associated Infections (HAI’s) Central Line Associated Bloodstream Infections (CLABSI) Catheter-Associated Urinary Tract Infections (CAUTI) Surgical Site Infections (SSI) C. difficile Infections (C-diff)* MRSA Bacteremia* ✳ Laboratory identified hospital onset

8. Central Line Associated Bloodstream Infections (CLABSI) What? Tube in the body for: Drawing blood Giving fluids Administering medication Can remain in body for weeks Usually placed in the neck, chest, arm or groin Symptoms Fever Chills Skin red / sore around catheter Prevention Do you still need it? If not, remove ASAP Everyone working with the catheter MUST wash hands Do not let family or friends touch the catheter

9. Catheter-Associated Urinary Tract Infections (CAUTI) What? UTI Tube inserted to drain the bladder Symptoms Burning / pain in lower abdomen Fever Bloody urine After the catheter is removed: Burning during urination Increase frequency to urinate Prevention Do you still need it? If not, remove ASAP Ask for other draining options, they are available! Everyone working with the catheter MUST wash hands BEFORE and AFTER Avoid disconnecting the catheter and drain tube, and kinking or twisting of the tubes Keep the bag lower than the bladder to prevent backflow Empty the bag regularly; do not allow drainage spout to touch ANYTHING!

10. Surgical Site Infections (SSI) What? An infections at the site / location of a surgery Symptoms Skin red / sore around site Drainage of fluid from site Fever Prevention Before 1)Provide a complete medical history 2)Quit smoking 3)DO NOT shave near surgery site During 1)SPEAK UP if someone tries to shave you 2)Get antibiotics 60 minutes before They should stop within 24 hours after surgery After 1)Everyone who touched you should WASH THEIR HANDS! 2)Do not let family or friends touch the surgical site

11. Clostridium Difficile (C-diff) – Part 1 What? A germ that causes diarrhea Usually the patient is also taking antibiotics Symptoms Watery diarrhea Fever Loss of appetite Nausea Belly pain and tenderness

12. Clostridium Difficile (C-diff) – Part 2 Prevention ALL hospital personnel should wash their hands before helping you Take antibiotics as prescribed Wash your OWN hands often. Especially: After using the bathroom Before eating Have family and friends: Wash their hands BEFORE and AFTER visiting with you Ask for protective gowns and gloves Difficult to control 1)Spores can live outside the human body for a long time 2)Can live on: bed linens, bed rails, bathroom fixtures, medical equipment 3)Can spread person to person via contaminated equipment OR from the hands of hospital personnel

13. MRSA Bacteremia Prevention ALL hospital personnel should wash their hands before helping you Have family and friends: Wash their hands BEFORE and AFTER visiting with you Ask for protective gowns and gloves Difficult to control 1)Can live on: bed linens, bed rails, bathroom fixtures, medical equipment 2)Can spread person to person via contaminated equipment OR from the hands of hospital personnel What? Form of Staph that is VERY COMMON 1 out of 3 people carry it with no issue If an infection develops, it is resistant to typical antibiotics

14. Quiz #1 – Match the germ with the cleaner that will KILL it GERM CLEANER HINT: Each cleaner is ONLY used once.

15. Quiz #1 – Match the germ with the cleaner that will KILL it GERM CLEANER HINT: Each cleaner is ONLY used once.

16. Founded in 2001 Flagship initiative: Leapfrog Hospital Survey First released June, 2001 Other initiatives: First released Spring, 2012 FLHCC is a founding member

17. Hospital Safety Survey New cycle starts in the spring each year 2015 stats: Florida – 213 invited; 129 participated Nationally – 3811 invited; 1750 participated 2 nd highest participation as a regional leader 3 rd highest participation as a state The results from the survey are used in the safety score If a hospital does not answer the questions or the entire survey (like the 213-129 = 84 above) they are reported as declined to respond.

18. Another Quiz – Question 1 In regard to preventing hospital-acquired infections related to inadequate hand hygiene, our organization has done the following or has had the following in place within the last 12 months: A)Conducted a hospital-wide evaluation of the potential impact of improvements in hand hygiene on the frequency and severity of hospital-acquired infections in our patient population. B)Submitted a report to the Board (governance) with recommendations for measurable improvement targets. 2016 Leapfrog Hospital Survey – Hard Copy version 6.3 Awareness

19. Another Quiz – Question 2 In regard to preventing hospital-acquired infections related to inadequate hand hygiene, our organization has done the following or has had the following in place within the last 12 months: A)Held clinical leadership directly accountable for this patient safety area through performance reviews or compensation. B)Held senior administrative leadership directly accountable for performance in this patient safety area through performance reviews or compensation. C)Held the patient safety officer directly accountable for improvements in performance through performance reviews or compensation. D)Reported to the Board (governance) the results of the measurable improvement targets. 2016 Leapfrog Hospital Survey – Hard Copy version 6.3 Accountability

20. Another Quiz – Question 3 In regard to preventing hospital-acquired infections related to inadequate hand hygiene, our organization has done the following or has had the following in place within the last 12 months: A)Conducted staff education/knowledge transfer and skill development programs, with attendance documented. B)Documented expenditures on staff education related to this Safe Practice in the previous year. 2016 Leapfrog Hospital Survey – Hard Copy version 6.3 Ability

21. Another Quiz – Question 4 In regard to preventing hospital-acquired infections related to inadequate hand hygiene, our organization has done the following within the last 12 months or has had the following in place during the last 12 months and updates are made regularly: A)Developed and implemented explicit policies and procedures across the entire organization to prevent hospital-acquired infections due to inadequate hand hygiene including CDC guidelines with category IA, IB, or IC evidence. B)Implemented a formal performance improvement program addressing hospital-acquired infections focused on hand hygiene compliance, with regular performance measurement and tracking improvement OR monitored a previously implemented hospital-wide performance improvement program that measures, and demonstrated full achievement of, the impact of this specific Safe Practice. 2016 Leapfrog Hospital Survey – Hard Copy version 6.3 Action

22. Hand Hygiene Results A total of 30 points are available 5 are awarded for answering the question If no answers are given

24. Only 1,750 hospitals complete a survey 2,571 receive a score Score data comes from (no order): Leapfrog Hospital Safety Survey American Hospital Association (AHA) Annual Survey AHA Health Information Technology (HIT) Supplement Centers for Medicare and Medicaid (CMS)

25. and Infections CMS requires hospitals to submit to the CDC’s National Healthcare Safety Network. SSI C-Diff MRSA CLASBI CAUTI

26. How to Read the Results

27. Other Tools that might be useful ICE – In Case of Emergency www.campaignzero.org

28. Resources & Thank you! Ashley Tait-Dinger, MBA Director, Quality & Value Measurement ASHLEY@FLHCC.ORG CDC Healthcare Associated Infections site: https://www.cdc.gov/hai/ 1 page FAQ’s https://www.cdc.gov/HAI/bsi/bsi.html HAI Progress Report 2016 (based on 2014 data) http://www.cdc.gov/hai/surveillance/progress-report/ Also included information state by state. The Leapfrog Group http://www.leapfroggroup.org Hospital Safety Survey http://www.leapfroggroup.org/compare-hospitals Hospital Safety Score http://www.hospitalsafetyscore.org