Public Reporting of Health Care–Associated Infections (HAIs): Approach to Choosing HAI Measures

2011 ◽  
Vol 32 (8) ◽  
pp. 768-774 ◽  
Author(s):  
C. L. Passaretti ◽  
P. Barclay ◽  
P. Pronovost ◽  
T. M. Perl ◽  
Keyword(s):  
Health Care ◽  
Antimicrobial Prophylaxis ◽  
Artery Bypass ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
The United States ◽  
Central Line ◽  
Public Reporting ◽  
Adverse Outcomes ◽  
Infection Prevention And Control

Objective.To develop a method for selecting health care–associated infection (HAI) measures for public reporting.Context.HAIs are common, serious, and costly adverse outcomes of medical care that affect 2 million people in the United States annually. Thirty-seven states have introduced or passed legislation requiring public reporting of HAI measures. State legislation varies widely regarding which HAIs to report, how the data are collected and reported, and public availability of results.Design.The Maryland Health Care Commission developed an HAI Technical Advisory Committee (TAC) that consisted of a group of experts in the field of healthcare epidemiology, infection prevention and control (IPC), and public health. This group reviewed public reporting systems in other states, surveyed Maryland hospitals to determine the current state of IPC programs, performed a literature review on HAI measures, and developed six criteria for ranking the measures: impact, unprovability, inclusiveness, frequency, functionality, and feasibility. The committee and experts in the field then ranked each of 18 proposed HAI measures. A composite score was determined for each measure.Results.Among outcome measures, the rate of central line–associated bloodstream infections ranked highest, followed by the rate of post–coronary artery bypass grafting surgical-site infections. Among process measures, perioperative antimicrobial prophylaxis, compliance with central-line bundles, compliance with hand hygiene, and healthcare-worker influenza vaccination ranked highest.Conclusions.Our qualitative criteria facilitated consensus on the HAI TAC and provided a useful framework for public reporting of HAI measures. Validation will be important for such approaches to be supported by the scientific community.

scholarly journals What do central venous catheter-associated bloodstream infections have to do with bundles?

2005 ◽  
Vol 16 (4) ◽  
pp. 215-218 ◽  
Author(s):  
BL Johnston ◽  
JM Conly
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Venous Catheter ◽  
The United States ◽  
Central Line ◽  
For Profit ◽  
Healthcare Improvement ◽  
Make Health Care

Interest in the patient safety agenda continues to grow in North America. In the United States (US), the Institute for Healthcare Improvement (IHI) has begun a campaign to make health care safer and more effective by encouraging hospitals to implement interventions they believe can avoid 100,000 deaths between January 2005 and July 2006 (1). The IHI, a not-for-profit organization founded in 1991, promotes the improvement of health by advancing the quality and value of health care (2). Three of the six areas for action chosen by the IHI for their '100,000 Lives Campaign' relate to prevention of nosocomial infections: central line infections, surgical site infections and ventilator-associated pneumonia. In Canada, a grassroots patient safety campaign modelled after the IHI's '100,000 Lives Campaign' has formed (3). This 'Safer Healthcare Now!' campaign focuses on the same six strategies chosen for the '100,000 Lives Campaign'. Across the country, hospitals are being invited to join the 'Safer Healthcare Now!' campaign.

Pay for Performance, Public Reporting, and Racial Disparities in Health Care

2007 ◽  
Vol 64 (5_suppl) ◽  
pp. 283S-304S ◽  
Author(s):  
Alyna T. Chien ◽  
Marshall H. Chin ◽  
Andrew M. Davis ◽  
Lawrence P. Casalino
Keyword(s):  
Health Care ◽  
Racial Disparities ◽  
Pay For Performance ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The United States ◽  
Public Reporting ◽  
Incentive Programs ◽  
Performance Incentive ◽  
Racial Disparities In Health

Pay-for-performance and public reporting programs may have a neutral, narrowing, or widening effect on racial disparities in health care. The authors begin this article by suggesting that certain characteristics of these programs may affect disparities. They then present results from a systematic review of the literature on the effects of performance incentive programs on racial disparities in health care. The review revealed that only one empirical study provided data on this issue: It showed that a major public reporting program increased disparities in coronary artery bypass graft rates. The authors then present the results of interviews with leaders of 15 major performance incentive programs in the United States. The interviews indicated that current programs are not designed to reduce disparities and often lack characteristics that may be important in reducing disparities. The article concludes with program leaders' recommendations on how performance incentive programs could be designed to reduce disparities.

Summary of Evidence-Based Practices for Bloodstream Infection Prevention Across the Health Care Continuum of Care for Vascular Access Clinicians: Addressing the 3 Common Sources of Health Care-Associated Infection Transmission

2016 ◽  
Vol 21 (2) ◽  
pp. 72-74 ◽  
Author(s):  
J. Hudson Garrett
Keyword(s):  
Health Care ◽  
Vascular Access ◽  
Infection Prevention ◽  
Critical Role ◽  
Bloodstream Infections ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Evidence Based ◽  
Clinical Environment ◽  
Core Element

Abstract Infection prevention and control is a core element of patient safety and in the reduction of central line-associated bloodstream infections. These deadly infections can cause a mortality rate of approximately 12%–25% in inpatient populations. Bloodstream infections can in many cases be prevented through the adoption of evidence-based standards from organizations such as the Centers for Disease Control and Prevention and the Association for Vascular Access. Vascular access professionals play a critical role in infection prevention in patient care by practicing frequent hand hygiene, maintaining a clean and sanitary clinical environment of care, and performing proper skin antisepsis before the insertion of a vascular access catheter. Each of these interventions contributes to the overall goal of eliminating central line-associated bloodstream infections in these very vulnerable patients.

Health Care–Associated Infection Prevention and Control Programs

2012 ◽  
pp. 31-40
Author(s):  
W. Charles Huskins
Keyword(s):  
Health Care ◽  
Prevention And Control ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Basic Knowledge ◽  
Infection Prevention And Control ◽  
Control Programs ◽  
Health Care Associated Infection ◽  
Tract Infections ◽  
And Control

Infectious diseases subspecialists should have basic knowledge of interventions necessary to prevent and control health care–associated infections (HAIs). This chapter reviews key components and activities of HAI prevention and control programs. Subtopics addressed in other chapters include the following: interventions to prevent specific HAIs, such as intravascular catheter–associated bloodstream infections, ventilator-associated pneumonia, urinary catheter–associated urinary tract infections, and surgical site infections.

Prevention of healthcare associated infections

2019 ◽  
pp. 233-304 ◽  
Author(s):  
Nizam Damani
Keyword(s):  
Prevention And Control ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
And Control

This chapter provides the most up-to-date advice on infection prevention and control (IPC) of the four most common healthcare-associated infections (HAIs). These are: surgical site infections; infection associated with peripheral IV line/cannula and central line-associated bloodstream infections (CLABSIs); catheter-associated urinary tract infections (CAUTI); and hospital-acquired and ventilator-acquired pneumonias (VAP). The chapter examines and summarizes various key elements and discusses implementation of HAI care bundles and high impact interventions which are necessary to reduce these infections.

Chlorhexidine Bathing Effects on Health-Care-Associated Infections

2016 ◽  
Vol 19 (2) ◽  
pp. 123-136 ◽  
Author(s):  
Janette Denny ◽  
Cindy L. Munro
Keyword(s):  
Health Care ◽  
Bacterial Colonization ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Good Evidence ◽  
Health Care Associated Infections ◽  
Meta Analyses ◽  
Tract Infections ◽  
The Impact

Background: Health-care-associated infections (HAIs), infections that patients contract during the course of their hospitalization, are receiving a growing amount of attention. Heavy skin bacterial colonization aids in the transmission and development of HAIs. Nurses frequently use bathing with chlorhexidine gluconate (CHG) to reduce patients’ cutaneous microbial burden. This intervention has been shown to have promising but mixed results in the prevention of HAIs. Purpose: This article reviews the literature for evidence on the impact of CHG bathing on HAIs. Method: A literature search was conducted to identify peer-reviewed studies and meta-analyses that examined the impact of CHG bathing on HAIs using PubMed and CINAHL with the following search terms: CHG bathing AND healthcare associated infections, surgical site infections ( SSIs), central line associated bloodstream infections ( CLABSIs), ventilator-associated pneumonias ( VAP), catheter-associated urinary-tract infections ( CAUTIs), and Clostridium difficile-associated disease. The initial search identified 23 articles for review. Additional studies were identified by searching references used in original studies or review articles on this topic. Principle findings: There is good evidence to support incorporating a CHG bathing regimen to reduce the incidence of CLABSIs, SSIs, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) HAIs. Conclusion: As CHG becomes a standard practice to prevent HAIs, it is important to monitor for adverse reactions and evidence of resistance/susceptibility.

Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

2012 ◽  
Vol 33 (5) ◽  
pp. 500-506 ◽  
Author(s):  
Andrew M. Morris ◽  
Stacey Brener ◽  
Linda Dresser ◽  
Nick Daneman ◽  
Timothy H. Dellit ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Stewardship ◽  
Bloodstream Infections ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Public Reporting ◽  
Modified Delphi ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
The Impact

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

Health Care–Associated Infections

2012 ◽  
pp. 458-463
Author(s):  
Rodney L Thompson ◽  
Priya Sampathkumar
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Infectious Complications ◽  
Health Care Associated Infections ◽  
Health Care Associated Infection ◽  
Tract Infections ◽  
And Control ◽  
And Training

Health care–associated infection (HAI) is an infection that occurs in hospitals, nursing homes, clinics, or home health care programs. Infection control departments have been constituted to prevent and control infectious complications in health care settings. Prevention and control require combinations of education and training, procedures and policies, surveillance and reporting, and interventions that include isolation and teamwork. Common HAIs (nosocomial infections) include urinary tract infections, surgical site infections, bloodstream infections, and ventilator-associated pneumonia. Diagnosis and treatment of each type of infection are reviewed.

Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

2020 ◽  
Vol 41 (11) ◽  
pp. 1292-1297
Author(s):  
Michael L. Rinke ◽  
Suzette O. Oyeku ◽  
William J. H. Ford ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Ambulatory Surgery ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Retrospective Case ◽  
Additional Costs ◽  
Tract Infections ◽  
Healthcare Associated

AbstractObjective:Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.Design:Retrospective case-control study.Setting:Four academic medical centers.Patients:Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.Methods:Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.Results:Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).Conclusions:Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

scholarly journals Improved Subtyping ofStaphylococcus aureusClonal Complex 8 Strains Based on Whole-Genome Phylogenetic Analysis

mSphere ◽  
2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Jolene R. Bowers ◽  
Elizabeth M. Driebe ◽  
Valerie Albrecht ◽  
Linda K. McDougal ◽  
Mitchell Granade ◽  
...  
Keyword(s):  
Health Care ◽  
Staphylococcus Aureus ◽  
Clonal Complex ◽  
The United States ◽  
Infection Prevention And Control ◽  
Whole Genome ◽  
Content Type ◽  
Health Care Settings ◽  
Typing Scheme ◽  
Genomic Markers

ABSTRACTStrains ofStaphylococcus aureusin clonal complex 8 (CC8), including USA300, USA500, and the Iberian clone, are prevalent pathogens in the United States, both inside and outside health care settings. Methods for typing CC8 strains are becoming obsolete as the strains evolve and diversify, and whole-genome sequencing has shown that some strain types fall into multiple sublineages within CC8. In this study, we attempt to clarify the strain nomenclature of CC8, classifying the major strain types based on whole-genome sequence phylogenetics using both methicillin-resistantS. aureus(MRSA) and methicillin-susceptibleS. aureus(MSSA) genomes. We show that isolates of the Archaic and Iberian clones from decades ago make up the most basal clade of the main CC8 lineages and that at least one successful lineage of CC8, made up mostly of MSSA, diverged before the other well-known strain types USA500 and USA300. We also show that the USA500 type includes two clades separated by the previously described “Canadian epidemic MRSA” strain CMRSA9, that one clade containing USA500 also contains the USA300 clade, and that the USA300-0114 strain type is not a monophyletic group. Additionally, we present a rapid, simple CC8 strain-typing scheme using real-time PCR assays that target single nucleotide polymorphisms (SNPs) derived from our CC8 phylogeny and show the significant benefit of using more stable genomic markers based on evolutionary lineages over traditionalS. aureustyping techniques. This more accurate and accessibleS. aureustyping system may improve surveillance and better inform the epidemiology of this very important pathogen.IMPORTANCEStaphylococcus aureusis a major human pathogen worldwide in both community and health care settings. Surveillance forS. aureusstrains is important to our understanding of their spread and to informing infection prevention and control. Confusion surrounding the strain nomenclature of one of the most prevalent lineages ofS. aureus, clonal complex 8 (CC8), and the imprecision of current tools for typingS. aureusmake surveillance and source tracing difficult and sometimes misleading. In this study, we clarify the CC8 strain designations and propose a new typing scheme for CC8 isolates that is rapid and easy to use. This typing scheme is based on relatively stable genomic markers, and we demonstrate its superiority over traditional typing techniques. This scheme has the potential to greatly improve epidemiological investigations ofS. aureus.

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