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Impact of HAIs on the hospital 28-‐02-‐13
Andreas Voss, MD, PhD 1
Andreas Voss, MD, PhD Professor of Infec?on Control
RUNMC & CWZ Nijmegen, The Netherlands
¤ Are common
¤ Preven?on should be integral part of pa?ent care
¤ Morbidity and mortality (clinical burden)
¤ High financial impact (economic burden)
² On hospital services
² On costs of na?onal health care
¤ Pa?ent ² Addi?onal diagnos?c tests and treatment ² Extended hospital stay ² Temporary/permanent disability (death)
¤ Hospital ² Decreased produc?on (beds blocked) ² Claims and li?ga?on ² Reimbursement too low or excluded (DRG, NI-‐MRSA) ² Reputa?on/image damage (decrease referrals)
¤ Society ² Loss of labor
¤ Measurement is difficult ¤ Financial impact varies between different healthcare-‐se]ngs, -‐systems and countries
¤ “High costs” repeatedly demonstrated
¤ Increased awareness with regard to the importance of infec?on control
¤ Added value of individual IC components “s<ll unknown”
"Improving pa<ent safety in the EU” Rapport for the European Commission
Published in 2008 by RAND Co.
Technical report "Improving pa?ent safety in the EU", drabed the Europeam Commission, published in 2008 by RAND Corpora?on.
¤ The es?mate for the member states is that between
8% en 12% of the hospitalized pa?ents experience
unintended complica?ons
¤ On average 1 in 20 hospital pa?ents will develop a NI
¤ In the EU: 4.1 miljoen pa?ënten per year resul?ng in
the death of 37 000 pa?ents
Impact of HAIs on the hospital 28-‐02-‐13
Andreas Voss, MD, PhD 2
8 mil
60 mil 1.66/1,000 inhab.
8.75/1,000 inhab.
10.000 GBD/case
4300 CHF/case
Wilcox MH, Dave J. The cost HAI and the value of infec?on control. J Hosp Infect 2000;45:81-‐4
… manda?ng hospitals to publically report HAI rates and a federal pay-‐for-‐performance measure that will no longer allow Medicare to pay more for pa?ents with HAIs
=
… we would have been born with a zipper and spare parts using a “click-‐system”
Impact of HAIs on the hospital 28-‐02-‐13
Andreas Voss, MD, PhD 3
¤ Shame & guilt
¤ Hepa??s, HIV ¤ STD-‐pathogens, HPV, … ¤ TB, respiratory-‐viruses
¤ Teaching-‐hospital
¤ 560 beds, 32000 admissions/yr, 24000 day-‐ admissions/yr, OPC for the larger region
¤ 3km away from UMC
¤ Full microbiology and ID service (3.3 be)
¤ Infec?on control (2 x 0.5be MD, 4.6 be ICP)
¤ Regional infec?on control
¤ Start in the ICU with 8 cases in December 2011 ² SDD as possible reason ² most pa?ents from 2 internal medicine units (oncol & dialysis)
¤ Screening of the 2 medical units: VRE prevalence 25%
¤ Prevalence screening hospital-‐ wide: 4 other units with high prevalence of VRE
¤ Outbreak management team (core) ² CEO, head IC, chair medical staff, coordina?ng unit manager, head communica?on
¤ Outbreak management team (large) ² Ini?ally all medical and nursing heads of implemented units (must) and other units (can), communica?on, fascility management
² Aber 3 months: all unit managers (n=22)
¤ Environment has to be free of VRE ² problem bed-‐pans (washers) & commodes
¤ Handhygiene needs to be improved ² rings, watches, long sleeves
¤ All pa?ents on correct cohort (VRE+, -‐, ?) ² Flagging of pa?ents in HIS
¤ Contact isola?on procedures correct ² “I dont know how”
¤ All HCWs trained ² Up to 70% new HCWs on some units
Impact of HAIs on the hospital 28-‐02-‐13
Andreas Voss, MD, PhD 4
¤ All “5-‐steps” are monitored per department on a weekly base
¤ Feedback in weekly OMT with managers ¤ Analysis and squeezing in weekly core OMT ¤ Monthy rapport to na?onal outbreak group
² all outbreaks need to be rapported ² several stages which can end in a na?onal team taking over outbreak control
¤ Roomservice ¤ Roomservice-‐plus ¤ RN ¤ Nursing assitent ¤ Cleaners
Vacant Responsibility !
Impact of HAIs on the hospital 28-‐02-‐13
Andreas Voss, MD, PhD 5
¤ Time ² 52 x OMT (x2 core and large)
² transfer to nurses on ward ² 100 training sessions “contact isola?on” ² Monthly up-‐date at medical staff and nursing staff mee?ng
² several leters to thousands of pa?ents, internal and external communica?on, calling center
¤ Produc?on ² reduced by approx. 20% on 6 wards
¤ Supplies
¤ Aber 2 x prevalence screening (hospital wide), weekly screening of pa?ents in 6 units ² using in-‐house PCR
¤ Cultures from the environment (bed-‐pans and commodes, if visibly soiled at audits)
¤ Typing of VRE-‐isolates (AFLP, MLST)
¤ EUR 2.000.000 ² excluding loss in produc?on ² 10% is covered by insurance
¤ Probably no “image damage” ² one of 10 hospitals with VRE problem ² open communica?on, na?onal symposium ² 98% coloniza?on, overall 5 clinical infec?ons including 2 BSI à all successfully treated with teicoplanin (vanB)
June 25-‐28, 2013 Geneva Switzerland
www.icpic2013.com