1. 2012 Middle TN APIC Chapter Conference 9-13-12 Engaging our Most Valuable Resource in Infection Prevention: Our Patients J. Hudson Garrett Jr., PhD, MSN, MPH, FNP, CSRN, VA-BC, DON-CLTC, C-NAC Senior Director, Clinical Affairs PDI Healthcare

2. 2012 Middle TN APIC Chapter Conference 9-13-12 Financial Disclosures PDI Healthcare-Employee 2012 Conference Planning Committee Association for the Healthcare Environment Recommended Practices Advisory Board Association for Perioperative Registered Nurses Vice President, Board of Directors Vascular Access Certification Corporation President, Board of Directors SE Chapter of the Infusion Nurses Society Board of Directors, Education Chairperson Greater Atlanta Chapter Association for Professionals In Infection Control and Epidemiology

3. 2012 Middle TN APIC Chapter Conference 9-13-12 Program Objectives Discuss the role of the patient and family in the prevention of Healthcare Associated Infection Discuss strategies to include patient accountability for Joint Commission NPSG 7 Review patient and family involvement and empowerment strategies to reduce the incidence of HAIs

4. 2012 Middle TN APIC Chapter Conference 9-13-12 Healthcare-Associated Infections (HAIs)  1 out of 20 hospitalized patients affected  Associated with increased mortality  Attributed costs: $26-33 billion annually  HAIs occur in all types of facilities, including:  Long-term care facilities  Dialysis facilities  Ambulatory surgical centers  Hospitals

5. 2012 Middle TN APIC Chapter Conference 9-13-12 HHS Action Plan 5-year Goals Metric National 5-year Prevention Target Source Central line-associated bloodstream infections 50% reductionNHSN Adherence to central-line insertion practices 100% adherenceNHSN Clostridium difficile infections and hospitalizations 30% reductionNHSN, NHDS, HCUP Catheter-associated urinary tract infections 25% reduction NHSN MRSA invasive infections (population)50% reductionEIP Surgical site infections25% reductionNHSN Surgical Care Improvement Project measures 95% adherenceSCIP NHSN – CDC’s National Healthcare Safety NetworkEIP – CDC’s Emerging Infections Program NHDS – CDC’s National Hospital Discharge SurveySCIP – CMS’s Surgical Care Improvement Project HCUP – AHRQ’s Healthcare Cost and Utilization Project

6. 2012 Middle TN APIC Chapter Conference 9-13-12 Fundamental Question What role, responsibilities, and rights does the patient have in the HAI Prevention Process?

7. 2012 Middle TN APIC Chapter Conference 9-13-12 Could this be You Family Member?

8. 2012 Middle TN APIC Chapter Conference 9-13-12 What do these have in common?

9. 2012 Middle TN APIC Chapter Conference 9-13-12

10. Transmission of Infection

11. 2012 Middle TN APIC Chapter Conference 9-13-12 How Does Transmission Occur? Patient Healthcare Worker Environmental Surfaces Patient Care Equipment

12. 2012 Middle TN APIC Chapter Conference 9-13-12 How do you view mortality?

13. 2012 Middle TN APIC Chapter Conference 9-13-12 The Story Begins

14. 2012 Middle TN APIC Chapter Conference 9-13-12 Hand Hygiene Technique

15. 2012 Middle TN APIC Chapter Conference 9-13-12 Hand Hygiene Significant numbers of HAIs could be prevented if we practiced HH when indicated

16. 2012 Middle TN APIC Chapter Conference 9-13-12 Adherence to infection control guidelines is incomplete  Many HAIs are preventable with current recommendations  Failure to use proven interventions is unacceptable  Only 30%-38% of U.S. hospitals are in full compliance  Just 40% of healthcare personnel adhere to hand hygiene  Insufficient infection control infrastructure in non- acute care settings has allowed major lapses in safe care

17. 2012 Middle TN APIC Chapter Conference 9-13-12 Where do you even begin?

18. 2012 Middle TN APIC Chapter Conference 9-13-12 The Story Continues

19. 2012 Middle TN APIC Chapter Conference 9-13-12

20. External Pressures Payment Reform Decreased reimbursement Staffing Challenges Public Reporting Accountable Care Organizations NHSN

21. 2012 Middle TN APIC Chapter Conference 9-13-12 Patient Education-Long Lost Art Patient Print-Outs at Time of Discharge What about an interactive approach to patient and family education – Signs and Symptoms of Infection – Actions to Take if Suspected – How to communicate concerns with your healthcare provider – Activating RRT

22. 2012 Middle TN APIC Chapter Conference 9-13-12 Family Support Psychologically beneficial in recoveryPrimary CaregiversHome Health SupportPatient AdvocacyPrimary Caregiver ResponsibilityBest Line of Defense

23. 2012 Middle TN APIC Chapter Conference 9-13-12 Patient’s versus Nurse’s responses to...

24. 2012 Middle TN APIC Chapter Conference 9-13-12 NPSG 7 Hand Hygiene MDROs – MRSA – CDI – VRE – MDR Gram Neg CLASBI SSI CAUTI

25. 2012 Middle TN APIC Chapter Conference 9-13-12 Speak Up Campaign

26. 2012 Middle TN APIC Chapter Conference 9-13-12

27. Antimicrobial Stewardship

28. 2012 Middle TN APIC Chapter Conference 9-13-12 Ten Steps for Safer Care-Part I Speak upKeep hands clean Ask if you still need a central line catheter or urinary catheter Ask your healthcare provider, "will there be a new needle, new syringe, and a new vial for this procedure or injection?" Be careful with medications

29. 2012 Middle TN APIC Chapter Conference 9-13-12 Ten Steps for Safer Care-Part II Get Smart about antibiotics. There are things you can do to reduce your risk of getting a surgical site infection. Watch out for C. diff Know the signs and symptoms of infection Get your flu shot

30. 2012 Middle TN APIC Chapter Conference 9-13-12 CDC knowledge and data fuels local to national CLABSI prevention Unit Facility Pittsburgh Regional Healthcare Initiative First successful, large-scale CLABSI prevention demonstration project Region al Subsequent projects based upon CDC prevention: Michigan Keystone Institute for Healthcare Improveme nt Others National National expansion of CLABSI prevention 60% Reduction in CLABSI between 1999-2009 State-based public reporting using NHSN State/regional prevention collaboratives (CUSP, Recovery Act projects) CMS/IPPS – hospitals report CLABSIs for full Medicare payment InputsOutputs Outbreak Investigations Prevention Research (e.g. chlorhexidin e bathing) NHSN DataCDC Guidelines

31. 2012 Middle TN APIC Chapter Conference 9-13-12 The need for HAI prevention research Healthcare-associated Infection  Need for complete implementation of practices known to prevent HAIs  Need for ongoing research to identify new strategies to prevent the remaining HAIs

32. 2012 Middle TN APIC Chapter Conference 9-13-12 Summary Patients and families are the last line of defense HCP should fully engage all of the care team and family to serve as advocates When it doesn’t seem right-it most likely isn’t Infection Preventionists are SMEs, but unit- based expertise is needed

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34. Payors Medical Professionals Consumers Public Health Patients Government Healthcare Facilities Safe Healthcare is Everyone’s Responsibility

35. 2012 Middle TN APIC Chapter Conference 9-13-12 Hypothetical ? If you knew………………………. That you could do something simple, easy, cost effective, and that was Evidence-Based, but took a little extra time….. Would you do it????? What if it was your loved one?

36. 2012 Middle TN APIC Chapter Conference 9-13-12 References US Centers for Disease Control and Prevention, www.cdc.gov/haiwww.cdc.gov/hai National Patient Safety Goals, The Joint Commission,, 2012. Speak Up Campaign, The Joint Commission, 2012. HAI Action Plan, US Department of Health and Human Services, 2012.

37. 2012 Middle TN APIC Chapter Conference 9-13-12 Questions Whose Infection will you prevent when you return to your institution? Contact Information: – Email: hgarrett@pdipdi.comhgarrett@pdipdi.com – Phone: 800-444-6725, ext. 8576