What’s New in the
Patient Safety World
December 2018
HAI Rates Drop
In 2016 there was a substantial reduction in hospital-acquired infections compared to 2015. According to the CDC (CDC 2018) the following reductions took place in US hospitals between 2015 and 2016:
· CLABSI’s decreased 11%
· CAUTI’s decreased 7%
· MRSA bacteremia decreased 6%
· C. diff events decreased 8%
· Ventilator-associated events decreased 2%
· SSI’s for abdominal hysterectomy decreased 13%
· SSI’s for colon surgery decreased 7%
Another recently published study on a sample of hospitals in 10 states (Magill 2018) had shown patients’ risk of having a health care–associated infection was 16% lower in 2015 than in 2011.
AHRQ 2018adata for 2014 through 2016 continue to show a downward trend in hospital-acquired conditions (which include much more than hospital-acquired infections) previously reported for 2010 to 2014. From 2010 through 2014, the rate of hospital-acquired conditions (HACs) decreased 17 percent. New data for 2014 to 2016 show an 8 percent decrease.
Various programs in hospitals have had positive roles in
reducing infections, including LEAN Six Sigma (Improta 2017),
leadership rounds (Knobloch
2017), a vascular access midlines program (Pathak
2018), hospital staffing (Mitchell
2018), and the U.S.
Department of Health and Human Services (HHS) Partnership for Patients (PfP) initiative, which was started in 2011 (AHRQ
2016). (Azar
2018) agile implementation”, to reduce CLABSI’s by 30% and also reduce
C. diff infections and SSI’s. A change in culture that occurred during the
implementation process was considered a key factor in its success.
IBM Watson Health (IBM Watson Health 2018) looked at HAC’s (hospital acquired conditions) in 2016 to assess both the human and financial costs of HAC’s. Keep in mind that hospital-associated infections are only are part of the overall spectrum of HAC’s. They found that there were over 48,000 HAC’s in 2016 and that these resulted in over 3000 potentially avoidable deaths. Moreover, this was associated with more than $2 billion in excess hospital costs. That calculates out to an average excess hospital cost of $41,917 per HAC patient. These HAC’s added, on average, 8.17 days per patient to average length of stay. They increased mortality risk per patient by 72.32%.
Another study (Anand 2018) looking at cost aspects of various inpatient harms found that surgical site infections were associated with about $30,000 additional costs per case. Hospital‐associated urinary tract infections added $6000 to $13,000 per case. Patients with preventable hospital-acquired conditions were also more likely to be readmitted within 90 days.
Some may be
surprised by the cost of CAUTI’s in the Anand study. We’ve previously noted
wide variation in the “attributable” costs of CAUTI’s (attributable costs are
costs that would not have been incurred had the CAUTI not occurred). In our
April 3, 2018 Patient Safety Tip of the Week “Cost
of a CAUTI” we highlighted a systematic review which showed the attributable
costs of CAUTI’s are very dependent upon the nature of the patient population
and location of services (Hollenbeak
2018). From that
review the authors note the attributable costs of a CAUTI were: $876 (inpatient
cost to the hospital for additional diagnostic tests and medications); $1,764
(inpatient cost to Medicare for non-intensive care unit [ICU] patients); $7,670
(inpatient and outpatient costs to Medicare); $8,398 (inpatient cost to the
hospital for pediatric patients); and $10,197 (inpatient cost to Medicare for
ICU patients).
(Magill 2018) noted there is still a need for further efforts to reduce C. diff related events. (CDC 2018) (Dalton 2018, Khanna 2012).
In addition to the numerous resources on preventing HAI’s in our multiple columns below, there a couple resources we’ve not previously mentioned. AHRQ (AHRQ 2018b) provides a variety of toolkits and resources to help healthcare organizations reduce the various hospital-acquired conditions. And Quick Infection Prevention Observation Tools
Some of our prior columns on HAI’s (hospital-acquired infections):
December 28, 2010 “HAI’s: Looking In All The Wrong Places”
October 2013 “HAI’s: Costs, WHO Hand Hygiene, etc.”
February 2015 “17%
Fewer HAC’s: Progress or Propaganda?”
April 2016 “HAI’s:
Gaming the System?”
September 2016 “More
on Preventing HAI’s”
November 2018 “Privacy
Curtains Shared Rooms and HAI’s”
Some of our other columns on central venous catheters and PICC lines:
January 21, 2014 “The PICC Myth”
December 2014 “Surprise
Central Lines”
July 2015 “Reducing
Central Venous Catheter Use”
October 2015 “Michigan
Appropriateness Guide for Intravenous Catheters”
March 27, 2018 “PICC
Use Persists”
Our other columns on urinary catheter-associated UTI’s:
- May 8, 2007 Tip of the Week “Doctor, when do I get this red rubber hose removed?”
- January 8, 2008 Tip of the Week “Urinary Catheter-Associated Infections”
- April 2008 What’s New in the
Patient Safety World column “More
on Nosocomial UTI’s”
- June 24, 2008 Tip of the Week “Urinary Catheter-Related UTI’s: Bladder Bundles”
- April 21, 2009 Tip of the Week “Still Futzing with Foleys?”
- June 9, 2009 Tip of the Week “CDC Update to the Guideline for Prevention of CAUTI”
- March 2010 “IDSA
CAUTI Guidelines”
- February 2011 What’s New in the Patient Safety World column “Catheters Not Needed in C-Sections?”
- January 2012 “CAUTI’s
Still Get No Respect”
- May 2012 “Foley
Catheter Hazards”
- November 2012 “CAUTI
Conundrum”
- December 18, 2012 “Unintended
Consequences of the CAUTI Measure?”
- January 2013 “Silver-Coated
Urinary Catheters Don’t Reduce CAUTI’s”
- June 2013 “Barriers
to CAUTI Prevention”
- November 2013 “Further
Reducing Urinary Catheter Use”
- June 2014 “Updated
HAI Prevention Guidelines from SHEA/IDSA”
- June 30, 2015 “What
Are Appropriate Indications for Urinary Catheters?”
- December 2015 “CAUTI
Prevention Tools”
- July 2016 “Holy
Moly, My Patient has a FOLEY!”
- December 2016 “The
Joint Commission NPSG for CAUTI’s”
- April 3, 2018 “Cost
of a CAUTI”
- September 25, 2018 “Foley
Follies”
Some of our other columns on handwashing and hand hygiene:
January 5, 2010 “How’s Your Hand Hygiene?”
December 28, 2010 “HAI’s: Looking In All The Wrong Places”
May 24, 2011 “Hand Hygiene Resources”
October 2011 “Another Unintended Consequence of Hand Hygiene Device?”
March 2012 “Smile…You’re on Candid Camera”
August 2012 “Anesthesiology and Surgical Infections”
October 2013 “HAI’s: Costs, WHO Hand Hygiene, etc.”
November 18, 2014 “Handwashing
Fades at End of Shift, ?Smartwatch to the Rescue”
January 20, 2015 “He
Didn’t Wash His Hands After What!”
September 2015 “APIC’s
New Guide to Hand Hygiene Programs”
November 2015 “Hand
Hygiene: Paradoxical Solution?”
April 2016 “Nudge:
An Example for Hand Hygiene”
August 2016 “Hand
Hygiene: Who’s Watching? Does it Matter?”
September 2016 “More
on Preventing bookmark’s”
July 18, 2017 “Another
Hazard from Alcohol-Based Hand Gels”
Some of our prior columns on antibiotic stewardship:
- October 14, 2014 “Antibiotic
Stewardship”
- November 2015 “Medications
Most Likely to Harm the Elderly Are…”
- July 2016 “NQF/CDC
Guideline on Antibiotic Stewardship”
- August 2016 “Some
Reassurance on Antibiotic Stewardship”
- November 2016 “C.
Diff and Your Predecessor’s Room”
- December 2016 “Update
on Ambulatory Antibiotic Stewardship”
- July 2017 “Antibiotics
and Adverse Events”
References:
CDC (Centers for Disease Control and Prevention). Healthcare-Associated Infection (HAI) Data for Various Healthcare Settings. CDC 2018
https://gis.cdc.gov/grasp/PSA/HAIreport.html
Magill SS, O’Leary E, Janelle SJ, et al. Changes in Prevalence of Health Care–Associated Infections in U.S. Hospitals. N Engl J Med 2018; 379: 1732-1744
https://www.nejm.org/doi/full/10.1056/NEJMoa1801550
Improta G, Cesarelli M, Montuori P, et al. Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy). Journal of Evaluation in Clinical Practice 2017; 24(2): 338-346 First published: 03 November 2017
https://onlinelibrary.wiley.com/doi/full/10.1111/jep.12844
Knobloch MJ, Chewning B, Musuuza J, et al. Leadership rounds to reduce health care–associated infections. American Journal of Infection Control 2018; 46(3): 303-310 Published online: November 2, 2017
https://www.ajicjournal.org/article/S0196-6553(17)31053-2/fulltext
Pathak R, Gangina S, Jairam F, Hinton K. A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital. Therapeutics and Clinical Risk Management 2018: 14: 1453-1456
Mitchell BG, Gardner A, Stone PW, at al. Hospital Staffing and Health Care–Associated Infections: A Systematic Review of the Literature. Joint Commission Journal on Quality and Patient Safety 2018; 44(10): 613-622
https://www.jointcommissionjournal.com/article/S1553-7250(17)30538-X/fulltext
AHRQ (Agency for Healthcare Research and Quality). National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data from National Efforts to Make Health Care Safer. AHRQ 2016
Azar J, Kelley K, Dunscomb J, et al. Using the Agile Implementation Model to Reduce Central Line-associated Blood Stream Infections. Am J Infect Control 2018; Published online September 7, 2018
https://www.ajicjournal.org/article/S0196-6553(18)30751-X/fulltext
IBM Watson Health. Hospital-Acquired Conditions lead to avoidable cost and excess deaths. IBM Watson Health 2018
https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=51020151USEN&
Anand P, Kranker K, Chen AY. Estimating the hospital costs of inpatient harms. Health Serv Res 2018; Early View published online Oct 11, 2018
https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13066
Hollenbeak CS, Schilling AL. The attributable cost of catheter-associated urinary tract infections in the United States: A systematic review. Am J Infect Control 2018; Published online: February 22, 2018
http://www.ajicjournal.org/article/S0196-6553(18)30036-1/fulltext
Dalton C. Dangerous Infection Tied To Hospitals Now Becoming Common Outside Them. NPR Vermont Public Radio 2018; November 25, 2018
Khanna S, Pardi DS, Aronson SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol 2012; 107(1): 89-95. Epub 2011 Nov 22
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273904/
http://ipcobservationtools.site.apic.org/observation-tools-library/
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