Be in the Know

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Be in the Know!

• Screening For and Preventing
• Hospital Acquired Infections

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HAI Hospital Acquired Infection

• Definition An infection not present or
  incubating prior to admittance to the hospital,
  but generally occurring 72 hours after
  admittance.
• As of October 1st, 2008, Medicare will no longer
  be reimbursing for HAIs.

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Patients at TG with an HAI
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Rate of HAIs on 6J
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Most Common types of HAI on 6J
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Most Common types of HAI on 6J

• UTIs and Wounds account for the most common types
  of HAI.
• Of all HAIs, at least 30 are present on
  admission.
• HAIs will cost thousands of dollars in lost
  revenue, and cause extended LOS.

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Adjusted Incremental Profit/(Loss) by
source(baseline 3/06-9/06)
8/3/2009
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No way, Not 6J!
Yes way! 47 UTIs in 9 months!
Jan 1st, 2007-Sept 31st, 2007
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Be in the Know!

• A NIMs study from June 2007-August 2007 showed
  that probably 38 of the HAIs for those months
  were pre-existing.
• Because infections caught within the first 48hrs
  are not HAIs, we need to screen on admission for
  UTI and wound infections.

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Be in the Know!

• Upon admission complete a thorough nursing
  assessment.
• For those patients with suspected UTI, collect
  specimen, call MD for order, and send the culture
  to the lab.
• For those patients with wounds that look
  infected, collect the specimen, call MD for an
  order, and send the culture to the lab.
• Positive culturesantibiotics soonerdischarge
  fasterexcluded as an HAI.

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Assessing for wound infections

• Inspect the patient from top to bottom!
• Look for areas of redness, swelling, warmth,
  pain, tenderness, and/or purulent drainage.
• Does the patient have a fever?
• Patients often complain of having a spider bite
  when it is actually MRSA!

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Assessing for UTIs

• Does patient complain of frequency, urgency, or
  painful urination?
• What does their urine look like?
• -Turbid?
• -Foul Smelling?
• -Bloody?
• Does the patient have a fever?

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Be in the Know!

• 5J tried this and look at their results

Intervention
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Be in the Know About UTIs

• Risks for UTI with an indwelling catheter
• Female gender
• Pt. with active infections or chronic conditions
• Improper position of drainage tubing and
  collection bag.
• Prolonged catheterization

• Other surprising facts
• UTIs have become an expected outcome in
  catheterized patients.
• Most frequent cause of sepsis.
• Urinary tract infections are the largest breeding
  ground of antibiotic resistant organisms.
• 11th leading cause of death in the U.S.

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Be in the Know Preventing UTIs

• According to the WHO, the 3 proven effective
  measures against UTIs are
• 1. Limit duration of catheter.
• 2. Aseptic technique at insertion.
• 3. Maintain closed drainage.

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Be in the Know Preventing UTIs

• A large perspective study monitored compliance
  on a daily basis of catheter care and the only
  violation predictive of an increased risk of UTI
  was improper position of the drainage tube, above
  the level of the bladder or sagging below the
  level of the collection bag (Maki, 2001).

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Preventing InfectionHand Washing

• The main mode of transmission of MRSA is from
  human hands.
• Hand washing is the number one defense against
  germs.
• Be an advocate for your patient You washed your
  hands, but did the M.D., OT, PT, RT, etc?

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Preventing InfectionStethoscopes

• In a study of 150 health care workers (50
  paramedics, 50 nurses, and 50 doctors)
  staphylococcus species were cultured from 89 of
  participants stethoscopes.
• Cleaning the stethoscopes diaphragm resulted in
  an immediate reduction in the bacterial countby
  94 with alcohol swabs.
• The level of contamination rises from 0 to 69
  after more than one day without cleaning of the
  stethoscope.
• (Saloojee Steenhoff, 2001)

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Conclusion

• While HAIs cost thousands of dollars to treat,
  the bottom line is that reducing HAIs leads to
  better patient outcomes.

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References

• Centers for Disease Control (2007, October 3).
  MRSA in healthcare settings. Retrieved
  February 24, 2008, from http//www.cdc.gov/ncidod
  /dhqp/ar_MRSA_spotlight_2006.html
• Ducel, G., Fabry, J., Nicolle, L. (2002).
  Prevention of hospital acquired infections a
  practical guide (2nd ed.). Geneva, Switzerland
  WHO.
• Easton, P. M., Sarma, A., Williams, F., Marwick,
  C. A., Phillips, G., Nathwani, D. (2007).
  Infection control and management of MRSA
  assessing the knowledge of staff in an acute
  hospital setting. Journal of Hospital Infection,
  66, 29-33.
• Neergaard, L. (2008, February 19). Medicare won't
  pay hospital for errors. Retrieved February 23,
  from http//www.theolympian.com/national/story/364
  196.html
• NIM (2007). nosocomial infection marker charts.
  Unpublished raw data.
• Peck, P. (2007, August 20). Medicare buck stops
  at paying for hospital mistakes. Retrieved March
  3, 2008, from http//www.medpagetoday/PublicHealt
  hPolicy/MedicaidMedicare/tb/6457
• Saloojee, H., Steenhoff, A. (2001). The health
  professional's role in preventing nosocomial
  infections. Postgraduate Medical Journal, 77,
  16-19.