IHC Work Plan Description — Clinical Initiatives (pg. 2)
IHC Healthcare-Associated Infections Work Group
IHC believes that clinical improvement and the spread of best practice in HAIs will be accelerated through a provider-led exercise in self-reporting. IHC began this effort in September of 2005. The objectives of this initiative:
- Increase awareness about HAIs among providers and the public.
- Convene a discussion in the Iowa healthcare community to standardize definitions and metrics around infection reporting.
- Promote public reporting of HAI information in Iowa.
The HAI Work Group was convened with Iowa experts in infectious disease. It includes physicians from health systems across the state, the state epidemiologist, infection control practitioners (ICPs), representatives of hospital management, and specialists in performance improvement.
The group adopted the 2005 HICPAC Report as a set of guiding principles. A survey of existing reporting practices in Iowa found that there is great variability in current tracking of infectious disease. Even in cases where there are standard measures, hospitals may follow guidelines of different national organizations. The first step to reporting HAI information to the public is agreement on standard measures and definitions.
With this in mind, the HAI Work Group strategy for 2006 focused on:
- Increasing awareness and alignment around HAIs in the provider community.
- Development of a set of measures, consistent with national initiatives, to be used for public reporting in Iowa.
- Public reporting of HAIs.
- Equipping hospitals to report the new measures in 2007.
Current Status
IHC is working to deploy a set of consistent and evidence-based measures across the state. The goals are to decrease institutional variability in the interpretation and use of HAI measurements, as well as improve public access to HAI information.
- HAI Toolkit - IHC produced a toolkit to align and equip infection control healthcare providers in the state. It provides detailed information about HAI reporting in 2007 and practical applications to improve performance.
- Identification of 2006 Measures Set - After review of existing data and the consistency of reporting, the HAI Work Group chose three measures from the current CMS reporting data set as a core for the new HAI section of this report:
- PN-2: Pneumococcal Vaccination
- SIP-1: Prophylactic Antibiotic Received Within 1 Hour Prior to Surgical Incision
- SIP-3: Prophylactic Antibiotic Discontinued Within 24 Hours After Surgery End Time
- Web Reporting - IHC is constructing a web-based reporting vehicle to allow easy data entry.
- New Measures for 2007 Reporting - IHC is expanding the data set for the 2007 Iowa Report. The new measures reflect current national thinking and anticipate new national standards. Discussions have occurred across the ICP community in Iowa, and they have provided a commitment to consistent standards and definitions in HAI measurement and reporting.
- Healthcare Employee Influenza Vaccination Rate
Influenza vaccination of Health Care Workers (HCWs) is an important staff and patient safety issue. The national rate of influenza vaccination of HCWs is approximately 40 percent and widely acknowledged to be unacceptably low. HCWs are at great risk to acquire and transmit influenza to patients, their families, and the community in general. Vaccination decreases the disease burden on HCWs, reduces absenteeism, and helps maintain the healthcare workforce during influenza epidemics. The Centers for Disease Control and Prevention advocates an aggressive approach to HCW vaccinations.
- Central Line Infection Rate in the Intensive Care Unit
Outcomes measures should be chosen for reporting based on the frequency, severity, and preventability of the outcomes. They should also recognize the likelihood that they can be detected and reported accurately. A HICPAC-identified outcomes measure meeting these criteria is Central Line Infections in the Intensive Care Unit. The specific measure is central line-associated, laboratory-confirmed primary bloodstream infections in intensive care units.
- Surgical Site Infections
- Research indicates that Surgical Site Infections are the second most common type of adverse event occurring in hospitalized patients. While nationally the rate of surgical site infection averages between 2-3% for clean cases, an estimated 40-60% of these infections are preventable. Recently, significant national attention has been focused on this area through the Centers for Medicare & Medicaid Services, Joint Commission for Accreditation of Healthcare Organizations, National Quality Forum, and Institute for Healthcare Improvement.
- Four areas of surgical site infection will be reported including Coronary Artery Bypass Grafts (CABG), hip surgery, colon surgery, and hysterectomy.
Page One
- PN-2: Pneumococcal Vaccination
- SIP-1: Prophylactic Antibiotic Received Within 1 Hour Prior to Surgical Incision
- SIP-3: Prophylactic Antibiotic Discontinued Within 24 Hours After Surgery End Time
- Healthcare Employee Influenza Vaccination Rate
Influenza vaccination of Health Care Workers (HCWs) is an important staff and patient safety issue. The national rate of influenza vaccination of HCWs is approximately 40 percent and widely acknowledged to be unacceptably low. HCWs are at great risk to acquire and transmit influenza to patients, their families, and the community in general. Vaccination decreases the disease burden on HCWs, reduces absenteeism, and helps maintain the healthcare workforce during influenza epidemics. The Centers for Disease Control and Prevention advocates an aggressive approach to HCW vaccinations.
- Central Line Infection Rate in the Intensive Care Unit
Outcomes measures should be chosen for reporting based on the frequency, severity, and preventability of the outcomes. They should also recognize the likelihood that they can be detected and reported accurately. A HICPAC-identified outcomes measure meeting these criteria is Central Line Infections in the Intensive Care Unit. The specific measure is central line-associated, laboratory-confirmed primary bloodstream infections in intensive care units. - Surgical Site Infections
- Research indicates that Surgical Site Infections are the second most common type of adverse event occurring in hospitalized patients. While nationally the rate of surgical site infection averages between 2-3% for clean cases, an estimated 40-60% of these infections are preventable. Recently, significant national attention has been focused on this area through the Centers for Medicare & Medicaid Services, Joint Commission for Accreditation of Healthcare Organizations, National Quality Forum, and Institute for Healthcare Improvement.
- Four areas of surgical site infection will be reported including Coronary Artery Bypass Grafts (CABG), hip surgery, colon surgery, and hysterectomy.