Healthcare-associated Infections Description

Objectives

In September of 2005, IHC began this effort to reduce Healthcare-Associated Infections. The objectives:

1. Increase awareness about HAIs among providers and the public.
2. Convene a discussion in the Iowa healthcare community to standardize definitions and metrics around infection reporting.
3. Promote public reporting of HAI information in Iowa.

Project Team

IHC convened a Work Group that includes:

• Infectious Disease Specialists from the health systems across the state
• State Epidemiologist
• Infection control practitioners (ICPs)
• Hospital management
• Specialists in performance improvement
• The state Quality Improvement Organization, the Iowa Foundation for Medical Care

Metrics

The 2006 measures set represents existing measures taken from the CMS data set:

• SCIP 1 - Prophylactic Antibiotic Received Within 1 Hour Prior to Surgical Incision
• SCIP 3 - Prophylactic Antibiotic Discontinued Within 24 Hours After Surgery End Time
• PN 2 - Pneumococcal Vaccination

New measures will be added to the 2007 Iowa Report. These are described in greater detail in the Tools section of this toolkit. New measures IHC plans to include:

• Healthcare Worker Influenza Vaccination Rate
• Central Line Infection Rate in the Intensive Care Unit
• CABG Surgical Site Infection Rate
• Hip Arthroplasty Surgical Site Infection Rate
• Hysterectomy Surgical Site Infection Rate
• Colon Surgery Surgical Site Infection Rate

Selection Process

Through a series of meetings, surveys, and work days, the Project Team has:

• Reviewed both the status of the industry and the research community with regard to HAIs.
• Adopted the 2005 Report prepared by the Healthcare Infection Control Practices Advisory Committee (HICPAC) on public reporting as the foundational document.(2) The National Quality Forum’s 30 Safe Practices were also used to design next steps.
• Selected readily available HAI-related CMS data to include in the 2006 Iowa Report.
• Surveyed the state ICP community about Immunization of Healthcare Workers, Device-Related Infections, and Surgical Site Infections to determine reporting opportunities.
• Worked to stay congruent with national initiatives currently underway including the Surgical Care Improvement Project, the Institute for Healthcare Improvement’s 100,000 Lives Campaign, the National Quality Forum’s re-write of the 30 Safe Practices, and work by the CDC and others.
• Engaged the Iowa Infection Control and Epidemiology and Consultation Program as partners in this project.
• Defined a set of metrics for 2007 in healthcare worker immunization, central line infection, and selected surgical site infection to be added to the HAI section of the 2007 IHC Iowa Report.

Timeline

This project is designed to promote voluntary hospital reporting of a set of evidence-based measures on an annual basis beginning in 2007. It is expected that this reporting will continue into the foreseeable future.

• The third quarter of 2006 has been dedicated to preparing materials to educate the ICP community and hospitals about the 2007 reporting initiative. During this phase, a web-based data reporting vehicle and this toolkit were prepared.
• The fourth quarter of 2006 is designated for education and preparation for reporting. A series of conference calls with providers and the ICP community are planned to discuss the reporting set and procedures. This toolkit will be promoted and expanded. The web-based reporting vehicle will be available for trial reporting.
• The formal measurement period for 2007 will occur from January 1, 2007 – June 30, 2007. Data will be reported to the website on a monthly basis. Final information for this six-month sample must be submitted by September 1, 2007, to be included in the 2007 Iowa Report.
• Measurement will continue on a monthly basis. Beginning with the 2008 Iowa Report, information will be presented for 12 month reporting periods.

Project Status

The HAI Work Group has designed metrics, engaged the ICP community, built this toolkit, and endorsed public reporting. They will continue to meet to direct and advance this project. Currently, attention is focused on execution of this strategy. The work of this group will be presented at the IHC Annual Meeting in November. Data will be reviewed to prepare reporting formats that bring the most benefit to the state. Finally, it is expected that IHC will introduce new metrics and expanded reporting as the project advances.

References:
(2) Am J Infection Control 2005; 33:217-26.