INFECTION PREVENTION NEWSLETTER

Transcription

1 ST. JAMES HEALTHCARE JULY INFECTION PREVENTION NEWSLETTER Hospital-acquired infections linked to higher readmission rates INSIDE THIS Hospital acquired infections linked to higher readmission rates Key Steps to Prevent Central Line Infections SJH Central Line Procedural Checklist PCS 17 Rev. 4/ St. James Healthcare Infection Prevention Rates: Hand Hygiene CLABSI CAUTI C. difficile Montana DPHHS Pertussis Update Rare Infection Not New; Authored by Georgiana Mayer, PA MRSA and C. diff are not just harmful infections that lengthen hospital stays. They often lead patients back after they re discharged. By KEVIN B. O'REILLY, amednews staff. Posted May 8,. Physicians and hospitals may have another incentive to strictly follow infection control protocols preventing infections could lower readmission rates. Hospital patients with a positive clinical culture for methicillin resistant Staphylococcus aureus, vancomycin resistant enterococci or Clostridium difficile are 4% likelier to be readmitted within a year than other patients, said a study in the June Infection Control and Hospital Epidemiology. The cultures were ordered more than 48 hours after the patients initial admission, probably in response to some sign or symptom, meaning they probably acquired an infection in the hospital, researchers said. About % of Medicare patients are readmitted within a month, costing $17.4 billion annually, according to an April, 9, study in The New England Journal of Medicine. Hospitals with high readmission rates face up to a 1% cut in Medicare pay starting in October. We don t really need more reasons to prevent hospital associated infections, said Jon P. Furuno, PhD, the study s senior author. The cost, the patient morbidity and mortality are enough that we should be doing everything we can to reduce that burden. If we see that this association holds true and it s fairly intuitive that patients with infections are likelier to return to the hospital then I think that potentially reducing this burden of infections could also reduce readmissions. The patients benefit and clearly, now, we have financial incentives to try to [cut rehospitalizations] as well. About % of Medicare patients are readmitted within a month after a hospital discharge. The patients with a positive clinical culture were typically readmitted within a month of discharge, compared with about two months for patients with no infection, said the study, based on an analysis of 13,513 adult patients from 1 to 9 at the University of Maryland Medical Center in Baltimore. Hospitals may consider targeting patients who acquire infections during their stay as being at high risk for readmission and offer them an extra layer of discharge planning, patient education and follow up services, said Furuno, an epidemiologist and associate professor in the Dept. of Pharmacy Practice at the Oregon State University College of Pharmacy in Portland. Preventing infections before they occur probably will have the best payoff for hospitals and patients.

2 Page Key Steps to Prevent Central Line Infections Prior to Insertion Demand Strict Hand Hygiene Maximal Patient Barrier: Drape the patient with the full body drape (head-to-toe). Observe proper hand washing procedures either with conventional antiseptic-containing soap and water or with alcohol-based hand rub. Insertion: Insertion: The person inserting the central line should: The person inserting & those assisting should don maximal barrier precautions. Head cover Mask Sterile Gloves Sterile Gown Use chlorhexidine skin prep in a back-and-forth friction scrub. For the so-called dry sites (subclavian or jugular), prep for at least 3 seconds allowing a 3 second dry time. For the wet sites (femoral or groin), prep for at least minutes with a 1 minute dry time. Ensure that solution dries completely before attempting to insert the central line.

3 Page 3 SJH Central Line Protocol Check List (PCS-17) Rev 4/

4 Page 4 St. James Healthcare Infection Prevention Rates BSI Rate (per 1 CL Days) St. James CLABSI Rate (Device Related) NHSN Mean: 1.4 *UCL =.9 Jan-9 Apr-9 Jul-9 Oct-9 Jan-1 Apr-1 Jul-1 Oct-1 Jan- Mean = 1.5 Apr- Jul- 1 Oct- Jan- Apr- *UCL = Std Dev f rom Mean (Patient Risk Measure) 1 St. James CAUTI Rate (Device Related) NHSN Mean: 1.3 BSI Rate (per 1 CL Days) Mean = *UCL = Jan-9 Apr-9 Jul-9 Oct-9 Jan-1 Apr-1 Jul-1 Oct-1 Jan- Apr- Jul- Oct- Jan- Apr- *UCL = Std Dev from Mean (Patient Risk Measure) C-diff Rate (per 1 Pt Days) Jan-1 St. James C-diff Rate EVS education r/t cleaning procedures. 9.7 *UCL = Mean = Apr-1 Jul-1 Oct-1 Jan- Apr- Jul- Oct- Jan- Apr- *UCL = Std Dev from Mean (Patient Risk Measure) Housewide Hand Hygiene Compliance 1% 9% 8% 7% % 5% 4% 3% % 1% % 9% Benchmark Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May-

5 Page 5 Montana DPHHS Pertussis Update: // Year to Date (YTD) confirmed and probable cases reported to Montana DPHHS through Montana DPHHS Pertussis Update: // Year to Date (YTD) confirmed and probable cases reported to Montana DPHHS through Since January 1,, 38 cases of pertussis have been reported statewide, compared to 5 cases for the same period last year. jurisdictions in Montana have reported pertussis activity to date in. Among these jurisdictions, the number of pertussis cases reported ranges from 1 to 4. To date, 18 cases of pertussis are in infants < 1 year of age. Of these, four have been hospitalized. The overall incidence rate year to date is 31.1 pertussis cases per 1, Montana residents. Table 1: Montana Pertussis Case Counts by Jurisdiction, YTD // COUNTY/TRIBE Montana DPHHS June, CASE COUNT 1 POPULATION INCIDENCE per 1, NEW CASES (last 3 weeks) BIG HORN/ CROW/ N CHEYENNE 17, BLAINE/FT. BELKNAP 1, BROADWATER 5, 35. CASCADE 1 81, DAWSON 19 8,9.9 DEER LODGE 1 9, FLATHEAD 4 9, GALLATIN 1 89, HILL 3 1,9 18. JEFFERSON,4 5. LAKE 8, LEWIS AND CLARK 3 3, LINCOLN 19, MISSOULA 14 19,99.8 RAVALLI 5 4, RICHLAND 4 9, ROSEBUD/ N CHEYENNE 4 9, SILVER BOW 1 34,.9 STILLWATER 5 9, YELLOWSTONE 3 147, STATE 3 989,

6 Page Montana DPHHS Pertussis Update: // Year to Date (YTD) confirmed and probable cases reported to Montana DPHHS through To date, the 5-1 year and -18 year age groups represent the greatest number (5%) of pertussis cases. %

7 Page 7 Rare Infection Not New Nurse s Notes: excerpt from the Missoulian ; written by Georgiana Mayer, Nurse Practitioner at St. Patrick Hospital and St. James Healthcare Recent media reports highlighting the case of a 4 year old woman from Georgia have brought much attention to a bacterial infection called necrotizing fasciitis. Necrotizing fasciitis is a serious, life threatening rare bacterial infection. It affects the fascia, a sheet of tissue that covers and binds body structures together, and soft tissues of the body like muscle and fat. The media describes necrotizing fasciitis with the popular term flesh eating bacteria. This term developed because the infection spreads very quickly. However, this is not a new bacterial infection; descriptions of it date back to Hippocrates and the Civil War. There are two types of necrotizing fasciitis: type 1 is a mixed infection with more than one type of bacteria involved. Risk factors for type 1 infection include diabetes, peripheral vascular disease, recent surgery and people with a non functioning immune system. Type is caused by a bacteria called group A strep, which can occur in healthy people of any age group with no medical problems. The most common way to get this infection is through a skin injury such as a cut, blister, puncture wound, insect bite, burn, direct blow (injuring the tissue under the skin) or injection drug use. Bacteria enter the damaged skin and if it causes infection, it can spread to the fascia. Symptoms include tissue redness or swelling, and pain much worse than expected by looking at the wound. There may be large blisters, skin color changes from red to purple or even dusky blue, tissue crepitus (a crunchy feeling under the skin when you press on it), and flu like symptoms such as body aches, fever and fatigue. Health care providers diagnose necrotizing fasciitis by reviewing the patient s history and by physical exam. In addition, blood work, X rays, and a CAT scan or MRI scan may help make the diagnosis. Catching the infection early helps prevent it from spreading, damaging tissue, scarring and even death. Treatment includes early diagnosis, antibiotics and surgery to remove infected and necrotic (dead) tissue, pain medicine, good nutrition and wound care. Antibiotics alone are usually not enough to treat it. A surgeon may need to cut away the infected tissue to stop the infection from spreading. In the case of the Georgia woman, she cut her calf in a zipline accident. Emergency department personnel repaired the cut. She developed intense pain, returned to the emergency room, and two days later doctors diagnosed her with necrotizing fasciitis. Surgeons removed her left leg, right foot, both hands and some tissue on her abdomen. It is scary to hear stories like this but they are very rare. Necrotizing fasciitis does not spread from person to person. People can protect themselves this summer by taking good care of cuts and scrapes. Clean them as soon as possible, and keep them clean, dry and covered until healed. Watch closely for signs of infection redness, swelling, pain, pus drainage or fever and see your health care provider if any develop. If you are taking an antibiotic for a wound that becomes more swollen and painful, get rechecked right away. Check out any injury that seems to worsen quickly, especially if it is getting more and more painful. People with chronic conditions like diabetes, peripheral vascular disease or a decreased immune system should take care to avoid any skin injury. Watch for cuts or abrasions, and if they happen care well for them. A good place to find more information on necrotizing fasciitis is the Centers for Disease Control and Prevention website at TIBIOTICS AND HOSPI- STAY. UNDE TAL LENGTH OF