An Initiative of the Florida Hospital Association Hospital Improvement Innovation Network Infection Prevention Webinar Series: Implementation of Best Practices for Ventilator-associated Events (VAE) Prevention July 24, 2019
Agenda • Welcome & FHA Mission to Care HIIN Update – Cheryl Love, RN, BSN, BS-HCA, MBA, LHRM, CPHRM, Director of Quality and Patient Safety and Improvement Advisor, FHA • Infection Prevention Series: Implementation of “Best Practices” for VAE Prevention – Linda R. Greene, RN, MPS, CIC, FAPIC, Manager of Infection Prevention, UR Highland Hospital, Rochester, NY • Q&A • Upcoming HIIN Events and Opportunities • Evaluation Survey & Continuing Nursing Education
HIIN Core Topics – Aim is 20% reduction • Adverse Drug Events (ADE) • Catheter-associated Urinary Tract Infections (CAUTI) • Clostridium Difficile Infection (CDI) • Central line-associated Blood Stream Infections (CLABSI) • Hospital-onset MRSA Bacteremia • Injuries from Falls and Immobility • Pressure Ulcers (PrU) • Sepsis • Surgical Site Infections (SSI) • Venous Thromboembolisms (VTE) • Ventilator-Associated Events (VAE/IVAC/PVAP) • Readmissions (12% reduction) • Worker Safety
VAE Resources, Trainings and Tools Mission to Care Website FHA IVAC Call to Action Website HRET HIIN Website
UP Campaign: Spreading Cross Cutting Strategies Designed to reduce multiple forms of harm with simple, easy-to-accomplish activities that cut across several topics to decrease harm. Focused on four components: • SOAP UP: Hardwire Hand Hygiene • GET UP: Mobilize Patients • WAKE UP: Prevent Over-sedation • SCRIPT UP: Optimize Inpatient Medications 5
FHA Mission to Care Update: Ventilator-associated Condition Rate 8.0 7.5 7.0 6.5 6.0 5.5 Rate per 100 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 BL O-16 N-16 D-16 J-17 F-17 M-17 A-17 M-17 J-17 J-17 A-17 S-17 O-17 N-17 D-17 J-18 F-18 M-18 A-18 M-18 J-18 J-18 A-18 S-18 O-18 N-18 D-18 J-19 F-19 M-19 A-19 M-19 FL Rate 6.58 5.21 6.29 6.37 4.99 5.41 5.52 6.55 5.44 6.09 5.82 6.11 5.05 6.03 3.34 5.66 4.27 5.71 3.85 5.61 5.74 6.08 4.99 5.77 4.97 4.44 5.20 5.38 6.31 7.12 6.33 7.38 6.10 HRET HIIN Rate 4.93 4.82 4.60 4.96 4.96 4.85 4.69 4.98 5.27 4.97 4.75 5.00 4.77 5.32 4.51 5.13 5.05 4.99 4.81 5.43 4.88 5.33 5.16 5.26 4.94 5.03 5.22 5.27 5.06 5.67 5.25 5.36 5.18 # FL Reporting 76 74 74 75 76 76 76 75 75 76 76 77 76 75 73 73 72 68 68 68 72 68 69 69 69 73 73 72 72 71 71 67 60 #HRET HIIN Reporting 913 910 904 895 891 884 883 876 874 871 874 868 867 871 864 863 860 850 849 845 853 845 842 839 839 836 836 832 814 798 788 727 584 Source: HRET Comprehensive Data System, July 23, 2019
FHA Mission to Care Update: Infection-related Ventilator-associated Condition Rate 4.00 3.50 3.00 Rate per 100 2.50 2.00 1.50 1.00 0.50 0.00 BL O-16 N-16 D-16 J-17 F-17 M-17 A-17 M-17 J-17 J-17 A-17 S-17 O-17 N-17 D-17 J-18 F-18 M-18 A-18 M-18 J-18 J-18 A-18 S-18 O-18 N-18 D-18 J-19 F-19 M-19 A-19 M-19 FL Rate 2.20 1.83 1.86 2.48 2.33 2.31 2.53 2.29 2.39 1.85 1.48 2.38 2.87 2.45 0.89 1.77 1.23 1.97 0.94 1.94 1.88 1.52 1.09 1.58 1.06 0.85 2.01 0.89 1.37 1.67 2.11 2.05 2.28 HRET HIIN Rate 1.60 1.54 1.44 1.62 1.71 1.44 1.63 1.53 1.81 1.52 1.48 1.71 1.52 1.69 1.67 1.68 1.27 1.63 1.46 1.84 1.43 1.50 1.56 1.66 1.19 1.49 1.76 1.53 1.60 1.66 1.67 1.61 1.57 # FL Reporting 76 74 74 75 76 76 76 75 76 77 77 78 77 76 74 74 73 69 69 69 73 69 70 70 70 74 74 74 74 73 72 68 61 #HRET HIIN Reporting 910 914 907 894 893 885 883 876 875 871 875 871 870 873 865 862 858 849 847 845 851 845 844 841 841 835 834 831 812 799 786 724 582 Source: HRET Comprehensive Data System, July 23, 2019
FHA Mission to Care Update: Possible Ventilator Association Pneumonia (PVAP) 3.0 2.5 2.0 Rate per 100 1.5 1.0 0.5 0.0 BL O-16 N-16 D-16 J-17 F-17 M-17 A-17 M-17 J-17 J-17 A-17 S-17 O-17 N-17 D-17 J-18 F-18 M-18 A-18 M-18 J-18 J-18 A-18 S-18 O-18 N-18 D-18 J-19 F-19 M-19 A-19 M-19 FL Rate 0.68 0.60 0.12 0.22 0.68 0.34 0.66 0.25 0.76 0.96 0.85 0.48 0.37 1.09 0.34 0.73 0.41 0.71 0.46 0.89 1.53 0.50 1.29 0.59 1.26 0.69 0.90 0.73 1.64 0.76 1.07 0.51 0.41 HRET HIIN Rate 0.53 0.58 0.49 0.39 0.49 0.63 0.58 0.43 0.65 0.62 0.61 0.64 0.74 0.82 0.51 0.44 0.67 0.61 0.47 0.47 0.58 0.76 0.92 0.74 0.73 0.60 0.57 0.61 0.79 0.50 0.59 0.48 0.47 # FL Reporting 54 49 49 50 52 52 52 49 49 51 50 51 51 52 54 53 51 54 55 55 55 54 55 55 56 56 57 56 58 57 57 55 53 #HRET HIIN Reporting 605 669 671 659 687 683 681 679 683 683 687 686 689 693 698 692 694 695 693 692 698 699 701 701 704 705 712 708 697 688 684 619 496 Source: HRET Comprehensive Data System, July 23, 2019
FHA Mission to Care Update: Florida | Ventilator-associated Events
Infection Prevention and NHSN Virtual Series Date Topic Register Online Oct. 23, 2018 NHSN: SSI Surveillance Identification Event archive* and Analysis Nov. 20, 2018 SSI-Colon: How to Assess Root Cause Event archive* and Prevention Strategies Dec. 18, 2018 NHSN: VAE Surveillance Identification Event archive* and Analysis Event archive* Jan. 22, 2019 VAE: How to Assess Root Cause and Prevention Strategies Feb. 19, 2019 NHSN: MRSA Bacteremia Surveillance Event archive* Identification and Analysis Mar. 26, 2019 MRSA Bacteremia : How to Assess Root Event archive* Cause and Prevention Strategies Infection Prevention Boot Camp Resource Guide (May 30-31, 2019) *Access Event Archives (Recordings | Slides) on the Mission to Care HIIN Website 10
Surgical Infection Prevention (SIP) Webinar Series Date Topic Register Online Apr. 26, 2019 SIP Webinar Series #1: Event archive* Pre-operative Strategies for Prevention of SSI May 22, 2019 SIP Webinar Series #2: Event archive* Intra-operative Strategies for Prevention of SSI Jun. 25, 2019 SIP Webinar Series #3: Event archive will be posted online Post-operative Strategies for Prevention of SSI Preventing Post-Surgical Harm Resource Guide (Jun. 5, 2019) *Access Event Archives (Recordings | Slides) on the Mission to Care HIIN Website 11
VAE Assessment and Prevention Strategies Linda R. Greene, RN, MPS, CIC, FAPIC Linda_Greene@urmc.rochester.edu
Objectives Review VAE definition Discuss Current Literature related to VAE Describe key prevention strategies to prevent VAE
Polling Question What is your background? 1. IP 2. Respiratory Care 3. Quality 4. Nursing 5. Other
Background Estimate: 157,000 healthcare-associated pneumonias occur in acute care hospitals in U.S. with 39% being ventilator-associated* Ventilator-associated pneumonia (VAP) is an important complication of mechanical ventilation but other adverse events also happen to ventilated patients * Magill SS., Edwards, JR., Bamberg, W., et al. “Multistate Point-Prevalence Survey of Health Care- Associated Infections, 2011”. New England Journal of Medicine. 370: (2014): 1198-1208
Background Definition changed in 2013 Challenges with inter-rater reliability related to CXR No major changes except: Possible and Probable VAP- Now PVAP Pathogen updates
Let’s Review
Connect the Safety Dots Immobility Ventilator VAP VAC Harm Morbidity Pulmonary Mortality ARDS Edema IVAC Delays, LOS Atelectasis Antibiotic C Diff Cost$ Resistance infection
Broadening the Surveillance Intentional Associated Conditions: • ARDS • Pulmonary Edema • Thromboembolic disease • Sepsis Respiratory deterioration in previously stable patients is a risk factor for increased morbidity and mortality
The Chest X-RAY
Goal Get the patient off the ventilator sooner
Study A retrospective cohort study examining 20,356 episodes of mechanical ventilation (MV) 1 – VAEs • 1,141 ventilator-associated conditions (VACs) • 431 infection-related VACs (IVACs) • 266 possible cases of ventilator-associated pneumonia (PVAP) – Patients with a VAE have— • More days to extubation • More days to discharge • Higher mortality rate Klompas M, Kleinman K, Murphy MV . Descriptive epidemiology and attributable morbidity of • ventilator-associated events. Infect Control Hosp Epidemiol . 2014 May;35(5):502-10.
Risk Factors Risk factors for ventilator-associated events: A prospective cohort study Liu et al. / American Journal of Infection Control 47 (2019) 744 − 749
Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update • The true incidence of VAP is difficult to determine since traditional surveillance definitions are highly subjective. • Historically, 10-20% of ventilated patients developed VAP. • More recent reports suggest much lower rates but it is unclear to what extent these lower rates reflect better care versus stricter application of subjective surveillance criteria or better care Until studies are published on best strategies to prevent all VAEs, the • existing VAP prevention literature is the best available guide to improving outcomes for ventilated patients
Recommend
More recommend
