Linking Quality Improvement andInfection Prevention

Manoj Jain, MD, MPH

Medical Director, QSource

19 February, 2009

Objectives

Personal Journey in ID Personal Journey with QI What is QI? What are Quality Measures? Methods of QI – PDSA/Lean/Six Sigma Applying PDSA Cycle

Goals for Quality Improvement

Know Your Quality Indicators

• Rate of VAP

• Rate of UTI

• Rate of BSI

• Rate of SSI

• Rate of MRSA incidence

Outcome Measures inInfection Prevention

• Rate for hand washing compliance

• Antibiotic in a timely manner (within 1 hour) to reduce SCIP

• VAP bundle followed?

• Catheter days

Process Measures inInfection Prevention

Surgical Care ImprovementProject Performance Measures - Process

• Surgical infection prevention– Antibiotics

Administration within one hourbefore incision

Use of antimicrobialrecommended in guideline

Discontinuation within24 hours of surgery end

– Glucose control in cardiac surgery patients– Proper hair removal– Normothermia in colorectal surgery patients

• Measure the rates

• Educate others on how to reduce the rates, i.e., hand hygiene, prophylaxis antibiotics

• Encourage others to do interventions – hope the strategy works

• Result – rates remains the same.

Infection Preventionist’s Job

• If an outbreak occurs, then take action!!!

• In fact – the present rates are an outbreak

• We never had the tools to intervene

Infection Preventionist’s Job

• Goal is reducing infections

• Strategy is QI

• Tool is PDSA cycle

• Reducing infections is the Goal

• VAP and BSI are the outcome measures

• Hand Hygiene and bundles(checklist is the process measure)

What is QI? PDSA?

PDSA: The Wheel of Improvement

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Act Plan

Study Do

4 Elements of Change

• Multidisciplinary Teams– Staff ownership

• Flow Meetings– Administrative support

• Bundles– Evidence based medicine

• Culture of Change– Horizontal decision-making

Wheels in Motion:Continuous Quality Improvement

IMPACT: Patient OutcomesCan Improve

The overall surgical infection rate fell 27%, from 2.28% (215 infections among 9435 surgical cases) in the first 3 months to 1.65% (158 infections

among 9584 cases) between the first and the last 3 reporting months.Dellinger EP, et al. Am J Surg.2005;190:9–15.

Adverse Events Per ICU Day*

0

5

10

15

20

25

30

10/1/2002 12/30/2002 3/30/2003 6/28/2003 9/26/2003 12/25/2003 3/24/2004

Multidisciplinary Rounds

Hand Hygiene Protocol

Vent Bundles

ICU Medical DirectorCentral Line Bundles

UTI Bundles

* A list of event triggers that have been shown to be indicators of potential quality of care issues (See trigger tool)

Nosocomial Infection RatesFY 2001-FY 2004 YTD

ICU ALOS Per Episode

Average Cost Per ICU Episode

$3,406$2,874 $2,626

$0$500

$1,000$1,500$2,000$2,500$3,000$3,500$4,000

FY 2002 FY 2003 FY 2004 YTD

15.6% Decrease 8.6% Decrease

Public Reporting

• Public Reporting of Quality Data• CMS – Hospital/NH/Dialysis• AHRQ – State Data• Health Grades

Manoj Jain, MD, MPH

Medical Director, QSource

Thank You!

This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Contents do not necessarily reflect CMS policy. QSOURCE-TN-109.62-2008-04

Linking Quality Improvement andInfection Prevention