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.

 

And, according to AHRQ (AHRQ 2018a), data 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). Researchers at Regenstrief Institute and Indiana University School of Medicine (Azar 2018) borrowed a tool from software development, called “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).

 

One of the studies mentioned above (Magill 2018) noted there is still a need for further efforts to reduce C. diff related events. While the reduction in C. diff related events in 2016 (CDC 2018) is encouraging, there has also been evidence that C. diff related events are becoming more prevalent outside the hospital (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 APIC (Association for Professionals in Infection Control and Epidemiology) provides “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:

 

 

 

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:

 

 

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

 

 

AHRQ (Agency for Healthcare Research and Quality). AHRQ National Scorecard on Hospital-Acquired Conditions. Updated Baseline Rates and Preliminary Results 2014–2016. AHRQ 2018; June 2018

https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/natlhacratereport-rebaselining2014-2016_0.pdf

 

 

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

https://www.dovepress.com/a-vascular-access-and-midlines-program-can-decrease-hospital-acquired--peer-reviewed-article-TCRM

 

 

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

http://www.ahrq.gov/professionals/quality-patient-safety/pfp/2015-interim.html?utm_source=AHRQ&utm_medium=PR&utm_term=&utm_content=6&utm_campaign=AHRQ_NSOHAC_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

https://www.npr.org/sections/health-shots/2018/11/25/657861409/dangerous-infection-tied-to-hospitals-now-becoming-common-outside-them

 

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/

 

 

AHRQ (Agency for Healthcare Research and Quality). AHRQ's Healthcare-Associated Infections Program. Accessed October 15, 2018

https://www.ahrq.gov/professionals/quality-patient-safety/hais/index.html?utm_source=AHRQ&utm_medium=psls&utm_term=&utm_content=3&utm_campaign=AHRQ_ipw_2018

 

 

APIC (Association for Professionals in Infection Control and Epidemiology). Quick Infection Prevention Observation Tools. APIC 2018

http://ipcobservationtools.site.apic.org/observation-tools-library/

 

 

 

 

 

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