Reducing Healthcare Associated Infections (HAI): Barriers and Challenges (Text Version)

On September 27, 2010, Chris George made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (690 KB).  

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Slide 1

Reducing Healthcare Associated Infections (HAI): Barriers and Challenges

MHA Keystone Center for Patient Safety and Quality (MHA Keystone)

Chris George, RN MS
MHA Keystone Center for Patient Safety and Quality

AHRQ HAI Meeting
September 27, 2010

Slide 2

Core Project Team

HRET

• Deborah Bohr, PI
• Kevin Van Dyke
• John Combes, MD

MHA Keystone

• Sam Watson, Co-PI
• Christine George, RN
• Morgan Martin
• Kimberly Sepulvado, RN

Slide 3

Study Objectives

• Evidence-based Practice: How did clinicians and hospital staff learn about evidence-based practice to prevent and mitigate HAI's?
• Adaptive Work and the Comprehensive Unit-based Safety Program: How did teams get started with the adaptive work and what barriers were encountered?
• Critical Success Factors: What were the critical success factors in getting started?
• Future Research Needs: What types of AHRQ research are recommended?

Slide 4

Study Methods

• HAI Information Collection and Reporting Summary: completed by the infection prevention lead at each hospital.
• Patient Safety and Infection Prevention Catalogue: completed by the patient safety/quality improvement officers of each hospital.
• Patient Safety and Infection Prevention Assessment: clinicians and other staff.
• Semi-structured interviews with ICU coordinators at each facility.

Slide 5

Assessment Findings

Domain	Mean Hospital Score (highest=5)
	A N=20 CLABSI	B N=54 CAUTI	C N=24 VAP	D N=48 Sepsis
General Work Environment	4.5	3.9	4.1	4.3
Attitudes	4.4	4.2	4.2	4.3
Practices	3.8	3.8	3.9	4.0
	Mean % Yes Answers to Questions
Awareness of Patient Safety Training and Guidelines	75-95	86-94	96	92-98
Compliance with Patient Safety Practices	95	90	94	90

 

Slide 6

Context: The Michigan Experience

• History
• Results
• "Perfect is Possible"
• AHRQ and JHU collaboration

Slide 7

Comprehensive Unit-Based Safety Program (CUSP)

• AHRQ-funded JHU-MHA Keystone success
• CUSP elements:
• • Educate staff on the Science of Safety
  • Identify defects in care
  • Commit executive leadership to patient safety at the unit level

Slide 8

Participating MHA Keystone Hospitals

Facility	Type	# Beds	HAI Prevention Effort	Timeline	# IC FTEs
A	Small/rural, non-tertiary, community, non-profit	73	BSI	Early 2005	1.5
B	Tertiary, community, non-profit	243	CAUTI	2003	1.5
C	Tertiary, community, non-profit	411	VAP	Late 2003	2
D	Tertiary, teaching, community, non-profit	529	Sepsis	Early 2004	4

Slide 9

What Each Hospital Has in Common

• Experience in the Keystone ICU Collaborative since 2004
• Evidence-based practice specific to the HAI
• Comprehensive Unit-Based Safety Program

Slide 10

Barriers and Challenges

• Resistance from front-line staff
• Naivete about resource requirements
• Unrealistic data collection plans
• Lack of staff support for multidisciplinary rounds
• Time needed for practice change to take hold

Slide 11

Key Lessons

• Provide staff with strong evidence base
• Communicate expectations and require accountability
• Provide strong administrative support
• Do what works locally
• Use multiple venues to raise awareness and reinforce practice
• Observe staff on rounds and provide regular real-time feedback

Slide 12

Key Lessons (Cont.)

• Provide performance data at least quarterly and post in unit
• Establish Nurse Protocols
• CUSP critical to success
• Start small, then expand
• Use arsenal of QI tools; change management, systems, small cycle change, in addition to CUSP tools
• MD and RN champions essential

Slide 13

Next Steps

• Major need for implementation research
• Best practices for implementing latest evidence-based practice:
  • Dedicated time for clinicians
• Create this mindset in medical and nursing students-start education early!