Eliminating Hospital Acquired Infections

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Eliminating Hospital Acquired Infections

• Is it Possible?Is it Sustainable?Is it Worth It?

CCU / MICU Department of Medicine Allegheny
General Hospital
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Comparative Results
Overall rates (infections /1000 line days)
Risk of CLAB
1 in 22
1 in 185
 
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Are the Results Sustainable ?
Overall rates (infections /1000 line days)
Risk of CLAB
1 in 185
1 in 120
 
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What Happened??
FY05
FY04
Education
Standardization
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Why Did We Slip?

• 70 of the CLABs in FY05 were related to line
  placement issues
• We had not developed training for line placement
• Residents and fellows are masters of the work
  around
• We are using more and more PICC without proper
  technique and training

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Central Line Training ModuleWorkers have to be
given the training necessary to be successful

• 1 hour didactic with test
• The Perfect Line Placement Video
• Two Hours in the Line training Simulator
• Inter disciplinary (residents/fellows/nurses)

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Eliminating VAP

• July2004
• We implemented real time problem solving around
  every VAP case
• October, 2004
• We implemented countermeasures developed by the
  people doing the work (AGH VAP Bundle)
• July, 2005
• We assessed improvement compared to data from
  the previous 2 years

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The Results with VAP
(46)
(45)
(8)
VAP Bundle
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Eliminating VAPHow Did We Do It?

• Step 1 Elevate the head of the Bed 30?
• Step 2 Chlorhexidine mouthwash BID
• Step 3 Change vent tubing daily
• Step 4 Change suction catheter daily
• Step 5 provide a hook for hanging resuscitation
  bag

Total Added Cost 17/ intubated patient
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The Financial Losses due to VAP Are Sizable
(Excluded from the data are 57 non-VAP cases in
fiscal year 04/05 due to the lack of
reimbursement data on these cases)
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Best Clinical Outcome Does Not Reward AGH
VAP vs. Non-VAP Separated into Clinical Outcomes
(Excluded from the data are 57 non-VAP cases in
fiscal year 04/05 due to the lack of
reimbursement data on these cases)
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The Incentives Are Not Aligned with Outcomes
6,938
3,292
8,426
24,435
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Step 7 Estimate the Cost of the Intervention

• Variable costs of the actual components
• 0.4 / day (chlorohexidine mouthwash)
• 1.0 / day (clear and blue ventilator
  tubes)

1.4 / day
11.17 (average days on ventilator) 15.64
/ patient
0.58 / patient (Yankauer suction) 0.75
/ patient (resuscitation bag hook)
17 (per patient)

• No other costs associated with implementation
• - no special training for nurses
• - little additional time for nurses to perform

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Savings Are Likely to Far Exceedthe Costs of
Intervention
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CCU/MICU and HAIA Big Return on Investment

• Total Savings
• CLAB 1,235,765
• VAP 1,003,162
• Highmark PFP 2,100,000
• HAI elimination Initiatives 4,338,927
• Investment 34,927

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CCU/MICU and HAIThe Benefits are no Longer
Theoretical

• AGH has returned 1.5 million of the saving to
  further HAI elimination
• 400,000 to hire 8 respiratory therapists
• 350,000 for CLAB training module
• The CCU/MICU experience needs to be confirmed
  (PHC4/JHF collaborative)

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Summary

• Progress but by no means excellence
• Each class of HAI represent a enormous clinical
  and economic opportunity
• Training, commitment, and collaboration
• (not policies and guidelines) are needed.
• Excuses are no longer acceptable