the value of infection control can companies help bolster value? copyright 2002, robert garcia, bs,...
TRANSCRIPT
The Value of Infection Control
Can Companies Help Bolster Value?
Copyright 2002,
Robert Garcia, BS, MMT(ASCP), CIC
IC Responsibilities
• Range: all depts.• Nosocomial infection
surveillance• Communicable
diseases• Employee health• Sterilization assurance• Medical devices
• Sanitation• Antisepsis• Engineering &
Construction• Patient Safety• Regulatory
requirements• Bio-terrorism planning
The IC Profession at a Crossroads
• 12,000 ICPs and dwindling• Responsibilities up 75% in acute care and
81% in LTC• Staffing has not changed for 60% of IC
departments or decreased nearly 25%• 75% over 45 years of age• Most nurses, but where are the nurses?
Jackson MM, Soule B, Tweetn SS. APIC Strategic Planning Member Survey, 1997. The Emerging Healthcare Delivery Systems Task Force. APIC. AJIC AM J Infec Control 1998;26:113-25.
Lack of Nurses and Infection
• >15 studies and reports equate decreased RN nursing staff with increasing nosocomial infections
• Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and quality of care in hospitals. N Eng J Med 2002;346:1715-22
• Jackson M, Chiarello L, Gaynes R, et al. Nurse staffing and health care –associated infections: Proceedings from a working group meeting. AJIC AM J Infec Control 2002;30:199-206.
Nosocomial Infections
• 4th leading cause of death in U.S.
• >$4 billion dollar cost to hospitals
• LTC, Ambulatory, others $ = unknown
• Resistant organisms
• IOM Report
• Media reports
Prophetic Insight on Future Paths
“…Because we do not provide direct care to patients, the value of our practice must be demonstrated in other ways. We must translate infection control activities into proposals and systems that gain priority by
stressing quality and economy.”
Pantelick EL. Hospital infection control: Dinosaur or Dynasty. Am J Infect Control 1989;17:56-61.
APIC Research Foundation Priorities Project
• A review of the world’s literature on IC and ID over the last 20 years
• Identified 65 of most published authors
• 43 responded to survey
• #1 top priority: Cost-effectiveness/financial impact studies
Report from the Research Foundation, APIC Educational Conference & International Meeting, June 2000, Minneapolis, MN.
What is at Stake?
• For infection control professionals:– A necessary increase in institutional value
attained by sustained decease in infections and demonstration of cost reductions
• For Industry:– The confirmation that a proven and high quality
product does make a difference– Enhanced market position
An Emerging Methodology
Interventional Epidemiology
“…IE examines all functions from a global health care viewpoint; that is, it takes into consideration the potent changes outside of a healthcare organization and in response integrates this knowledge into the internal process systems of the facility.”
Garcia R, Barnard B, Kennedy V. The Fifth Evolutionary Era in Infection Control: Interventional Epidemiology. AJIC Am J Infect Control 2000;28:30-43
Communication Between Providers
People Procedures
VAP
PoliciesEquipment & Devices
VAP surveillance rounds (observational periods between IC and nurses)
Physicians
Nurses
Intubation/Extubation
Cleaning & maintenance of ventilator & components
Definition of VAP
Oral & Dental Care
Cleaning of ventilator & devices
Closed suction system, oral suction catheters, water, other suction devices, suction canisters/tubing
Mechanical ventilator (Heated humidifier or HME)
Tracheostomy devices
Closed suctioning
Use of H2 antagonists/sucralfate
Handwashing
Filters
Pharmacists
Intubation/Extubation
Analysis of System Components Influencing the Occurrence of Ventilator-Associated Pneumonia
Nutritional Specialists
Nasogastric tubes
Placement & maintenance of nasogastric tube
Respiratory Therapists
Handwashing
Suctioning (closed/oral)
Oral Care
Vent circuits, filters
NebulizersMultidose vials
LaryngoscopesResuscitation bags
Barrier equipment
Ventilator circuitsTracheostomy care
Cleaning of laryngoscopes Nebulizers
Suction canisters Resuscitation bags
Placement and care of nasogastric tubes
Enteral feeding Weaning
Self-extubationSemi-recumbent positioning
Relay surveillance data to healthcare providers
Feedback from healthcare providers