Thomas R. Talbot

Moving to a More Level Playing Field: The Need for Risk Adjustment of Publicly Reported Hospital CLABSI Performance - Volume 38 Issue 9 - Thomas R. Talbot

BACKGROUND: The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned.OBJECTIVE: To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications.DESIGN: Before-and-after quasi-experimental study with interrupted time-series analysis.SETTING: Academic medical center.METHODS: In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients.RESULTS: The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64–3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14–0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, −0.32).CONCLUSION: A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.Infect. Control Hosp. Epidemiol. 2015;36(11):1261–1267

Central venous catheter (CVC) day definitions do not consider concurrent CVCs. We examined traditional CVC day counts and resultant central line-associated bloodstream infection (CLABSI) rates with a CVC day definition that included concurrent CVCs. Accounting for concurrent CVCs increased device day counts by 8.5% but only mildly impacted CLABSI rates.Infect Control Hosp Epidemiol 2015;36(1): 107–109

Objective.: Exposure of healthcare personnel to bloodborne pathogens (BBPs) can be prevented in part by using safety-engineered sharp devices (SESDs) and other safe practices, such as double gloving. In some instances, however, safer devices and practices cannot be utilized because of procedural factors or the lack of a manufactured safety device for the specific clinical use. In these situations, a standardized system to examine requests for waiver from expected practices is necessaryDesign.: Before-after program analysis.Setting.: Large academic medical center.Interventions.: Vanderbilt University Medical Center developed a formalized system for an improved waiver process, including an online submission and tracking site, and standards surrounding implementation of core safe practices. The program’s impact on sharp device injuries and utilization of double gloving and blunt sutures was examined.Results.: Following implementation of the enhanced program, there was an increase in the amount of undergloves and blunt sutures purchased for surgical procedures, suggesting larger utilization of these practices. The rate of sharp device injuries of all at-risk employees decreased from 2.32% to 2.12%, but this decline was not statistically significant (P = .14). The proportion of reported injuries that were deemed preventable significantly decreased from 72.7% (386/531) before implementation to 63.9% (334/523; P = .002) after implementation of the enhanced program.Conclusions.: An enhanced BBP protection program was successful at providing guidance to increase safe practices and at improving the management of SESD waiver requests and was associated with a reduction in preventable sharp device injuries.

Due to the nature of their underlying illness and treatment regimens, cancer patients are at increased risk of infection. Though the advent and widespread use of anti-infective agents has allowed for the application of ever-greater immune-suppressing therapies with successful treatment of infectious complications, prevention of infection remains the primary goal. The evolutionary changes of microorganisms, whereby resistance to anti-infective therapy is increasingly common, have facilitated a paradigm shift in the field of healthcare epidemiology. No longer is the focus on “control” of infection once established in a healthcare environment. Rather, the emphasis is on prevention of infection before it occurs. The most basic tenet of infection prevention, and the cornerstone of all well-designed infection prevention and control programs, is hand hygiene. The hands of healthcare workers provide a common potential source for transmission of infectious agents, and effective decontamination of the hands reduces the risk of transmission of infectious material to other patients. Once infection is suspected or established; however, implementation of effective control strategies is important to limit the spread of infection within a healthcare environment. This chapter outlines the basic tenets of infection prevention, principles of isolation precautions and control measures, and elements for a successful infection control and prevention program.