The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals

Infection Prevention and Control Advisory CommitteeNovember 19, 2008Clare Kioski, MPH, CIC

Infection Control and Hospital Epidemiology; October 2008, Vol. 29. Supplement 1

http://www.shea-online.org/about/compendium.cfm

Compendium Partners

Society for Healthcare Epidemiology of America (SHEA)

Infectious Disease Society of America (IDSA)

The Joint Commission Association for Professionals in

Infection Control and Epidemiology (APIC)

American Hospital Association

Compendium Endorsers

American Organization of Nurse Executives (AONE)

Association for Respiratory Care (AARC) Infusion Nurses Society (INS) Pediatric Infectious Disease Society (PIDS) Society for Critical Care Medicine (SCCM) Society for Hospital Medicine (SHM) Surgical Infection Society (SIS)

Compendium Supporters

AARP Academy Health Agency for Healthcare

Research and Quality (AHRQ) American Academy of

Emergency Physicians American Association of Critical

Care Nurses American College of Physicians American College of Surgeons American Medical Association Cardinal Health Centers for Disease Control and

Prevention (CDC) Council of State and Territorial

Epidemiologists (CSTE)

HCA Health System Healthcare Infection Control

Practices Advisory Committee (HICPAC)

Institute for Healthcare Improvement (IHI)

International Society for Microbial Resistance (ISMR)

National Foundation for Infectious Diseases (NFID)

National Quality Forum (NQF) Premier, Inc. Society of Infectious Diseases

Pharmacists (SIDP) Trust for America’s Health

(TMAH) United Healthcare WellPoint Health Network

Six Categories of HAIs

Two focused on Specific Organisms Methicillin Resistant Staphylococcus

aureus (MRSA) Clostridium difficile infection (CDI)

Six Categories of HAIs

Four Device-and Procedure-Associated Central Line Associated Bloodstream

Infections (CLABSI) Ventilator Associated Pneumonia (VAP) Catheter-Associated Urinary Tract Infection

(CAUTI) Surgical Site Infection (SSI)

SHEA / IDSA Compendium

Compliments CDC guidelines Includes metrics and indicators of

success Updated guidance in areas where official

guidance is pending SSI and UTI guidelines are in preparation

Format suitable for implementation in a clinical setting.

Patient Guides

Developed by the SHEA Patient Safety and Quality Improvement Committee in collaboration with the Centers for Disease Control and Prevention (CDC)

Recommendation Format

Purpose Rationale and Statements of Concern Strategies to Detect Strategies to Prevent Recommendations for Implementing

Prevention and Monitoring Strategies Performance Measures

Strategies to Detect

Surveillance Protocol and definitions Use consistent surveillance methods and

definitions to allow comparison with benchmarkdata

Refer to the National Health and Safety Network (NHSN) Manual: Patient Safety Component Protocol

Strategies to Prevent

Existing guidelines and recommendations

Infrastructure requirements Practical approaches

Recommendations for Implementing Prevention and Monitoring Strategies Basic Practices Special Approaches

If rates are still high despite implementation of basic practices

Approaches that should NOT be considered

Unresolved issues

Performance Measures

Internal Reporting Process Measures Outcome Measures

External reporting State and federal requirements External quality initiatives

Strength of Recommendation and Quality of Evidence

Prevention of Central Line Associated Bloodstream Infections (CLABSI) Rationale and Statements of Concern

Increased length of hospital stay Increased Cost

$3,700-$29,000 per episode Risk Factors

Prolonged hospitalization before catheterization Prolonged duration of catheterization Heavy microbial colonization at insertion site Heavy microbial colonization of catheter hub

Prevention of Central Line Associated Bloodstream Infections (CLABSI) Strategies to Detect

Use NHSN Criteria Bloodstream infection (BSI)Definition Central Line Definition Denominator Description

Prevention of Central Line Associated Bloodstream Infections (CLABSI) Strategies to Prevent

Existing Guidelines & Recommendations Healthcare Infection Control Practices

Advisory Committee (HICPAC) Institute for Healthcare Improvement (IHI) Agency for Healthcare Research and Quality

(AHRQ) Infrastructure Requirements

Prevention of Central Line Associated Bloodstream Infections (CLABSI) Strategies to Prevent

Practical Implementation Educate physicians, nurses, and other

healthcare personnel Develop and implement catheter insertion

checklist Establish catheter insertion kits/carts

Prevention of Central Line Associated Bloodstream Infections (CLABSI) Basic practices for prevention and monitoring

Before Insertion Educate HCW on insertion, care and maintenance

of central venous catheters At Insertion

Use checklist to ensure adherence “bundle” Hand Hygiene (even when gloving) Avoid femoral veins Use all inclusive central line carts/kits Maximal barrier precautions Use chlorhexidine-based antiseptic for skin prep

Prevention of Central Line Associated Bloodstream Infections (CLABSI) Basic practices for prevention and monitoring

After insertion Disinfect catheter hubs, needleless connectors,

and injection ports before accessing catheters with alcoholic chlorhexidine preparation or 70% alcohol

Remove non-essential catheters Assess daily during multidisciplinary rounds

Change transparent dressings and perform site care with a chlorhexidine-based antiseptic every 5-7 days; change gauze dressings every 2 days

Prevention of Central Line Associated Bloodstream Infections (CLABSI) Basic practices for prevention and

monitoring After insertion

Replace administration sets not used for blood or lipids not longer than 96 hours

Use antimicrobial ointments for hemodialysis catheter insertion sites.

Prevention of Central Line Associated Bloodstream Infections (CLABSI) Basic practices for prevention and

monitoring Perform surveillance for CLABSI

Report data to units, physician and nursing leadership, and administration

Compare rates with national NHSN rates

Edwards JR et.al. National Healthcare Safety Network (NHSN) Report, data summary for 2006-2007, issued November 2008.. Am J Infect Control 2008; 36:609-26

Prevention of Central Line Associated Bloodstream Infections (CLABSI)- Special Approaches Lack of effective control despite

implementation of best practices. Bathe ICU patients with a chlorhexidine

preparation on a daily basis Use antiseptic- or antimicrobial-

impregnated central venous catheters for adult patients

Use antimicrobial locks for central venous catheters

Prevention of Central Line Associated Bloodstream Infections (CLABSI)Approaches NOT recommended Antimicrobial prophylaxis for short-term

or tunneled catheter insertion Replace Central venous catheters

routinely Use Positive-Pressure Needleless

connectors with mechanical valves before a thorough assessment

Updating the Compendium

SHEA/APIC/IDSA Standards and Practice Guidelines Committee will determine the need for revisions on the basis of examination of current literature at annual intervals.