210. Development of an ICU Report Card for Infection Prevention Practice Adherence
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 2013 ICU Report Card Poster [Compatibility Mode].pdf (218.5 kB)
  • Background:   Healthcare-associated infections (HAIs) are common and while evidence-based HAI prevention guidelines are widely available and outcomes publically reported, adherence to process measures is largely unknown. We aimed to identify adherence to evidence-based process recommendations for prevention of CLA-BSI, CAUTI, VAP, chlorhexidine (CHG) patient bathing, hand hygiene, and isolation precautions and develop a summary report for each ICU.

    Methods: From Jan-Mar 2013, 2 trained medical student observers, using standardized data collection forms, performed surveys evaluating infection prevention practices in 3 adult and 1 pediatric ICU.  Adherence to 12 recommendations (6 CVC, 5 urinary catheter, 1 ventilator) for prevention of device-associated infection was recorded.  Hand hygiene and isolation precaution adherence was assessed by direct observation.  CHG bathing was measured by product usage vs patient census.

    Results: Findings are presented in Table 1.   

    Criteria

    % Adherence

     

    ICU A

    ICU B

    ICU C

    ICU D

    CVC (N=631 device d)

     

     

     

     

      Avoid Femoral Site

    98.4

    90.8

    97.9

    95.3

      Dressing current/dated

    36.6

    30

    37.7

    31.3

      Dressing secure

    82.9

    94.6

    78.4

    98.4

      No more than scant blood under dressing

    71.1

    86.9

    100

    96.9

      No more than scant moisture under dressing

    98.8

    98.5

    84.9

    100

      Caps are intact/nonbloody

    85.8

    87.7

    85.3

    82.8

    Urinary Catheters (N=272 device d)

     

     

     

     

      Urine free flowing

    8.4

    1.5

    2.3

    85.7

      Sterile seal intact

    74.8

    79.7

    84.3

    14.3

      Catheter secure

    87.9

    91.3

    70.8

    100

      Bag placement correct

    99

    98.6

    98.8

    100

      Bag/ spout/graduated container is clean/dry/ intact

    100

    95.7

    100

    85.7

    Ventilator (N=185 device d)

     

     

     

     

      Head of bed > 300

    28

    62

    22

    90

    Hand Hygiene (507 opportunities)

    53.3

    57.1

    48.1

    63

    Hand Hygiene (unit based report  - 511 opportunities)

    90

    93

    64.5

    96

    Isolation (86 opportunities)

    88

    66.7

    75

    90.7

    CHG Bathing

    79

    84

    86

    54

    The pooled rate of CLABSI and CAUTI per 1000 device days for the ICUs was 1.6 and 2.64, respectively.  VAP data was not available due to recent changes in CDC definition. 

    Conclusion: We identified opportunities for improved adherence to process measures for HAI prevention and unit-specific itemized report cards were generated.  The comprehensive infection prevention report card should be useful in the development of unit-specific performance improvement projects.

    Marcie Richmond, MD1, Lisa Leavitt, MD1, Kate Tyner, RN2, R Jennifer Cavalieri, RN1, Trevor C Van Schooneveld, MD1,2 and Mark E. Rupp, MD, FIDSA, FSHEA3,4, (1)Internal Medicine, Univ of Nebraska Medical Ctr, Omaha, NE, (2)Infection Control & Epidemiology, Nebraska Medical Center, Omaha, NE, (3)Internal Med., Univ. of Nebraska Med. Ctr., Omaha, NE, (4)Infection Control & Epidemiology, The Nebraska Med. Ctr., Omaha, NE

    Disclosures:

    M. Richmond, None

    L. Leavitt, None

    K. Tyner, None

    R. J. Cavalieri, None

    T. C. Van Schooneveld, None

    M. E. Rupp, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.