Engaging our Most Valuable Resource in

Infection Prevention: Our Patients

Kim Neiman MPH BSN RN CIC VA-BC IP-BC

Clinical Science Liaison West Region
PDI Healthcare
Financial Disclosures
PDI Healthcare-Employee
 Program Objectives
• Discuss the role of the patient and family in
the prevention of healthcare associated
infections (HAI).
• Discuss Joint Commission NPSG 7 and the
patient’s role in infection prevention
• Review patient and family involvement,
educational tools and empowerment
strategies to reduce the incidence of HAIs
 Healthcare-Associated Infections (HAIs)
 1 out of 25 hospitalized patients
affected
 Associated with increased mortality
 Attributed costs: $26-33 billion
annually
 HAIs occur in all types of facilities,
including:
 Long-term care facilities
 Dialysis facilities
 Ambulatory surgical centers
 Hospitals
 HHS 2020 Action Plan for Acute Care Facilities
 The measures will track population-based harm from HAIs at the
national level. These measures address the following goals from the HAI
Action Plan:
• Reduce central line-associated bloodstream infections (CLABSI) in
intensive care units and ward-located patients
• Reduce catheter-associated urinary tracts infections (CAUTI) in intensive
care units and ward-located patients
• Reduce the incidence of invasive health care-associated methicillin-
resistant Staphylococcus aureus (MRSA) infections
• Reduce facility-onset methicillin-resistant Staphylococcus aureus (MRSA)
in facility-wide health care
• Reduce facility-onset Clostridium difficile infections in facility-wide
health care
• Reduce the rate of Clostridium difficile hospitalizations
• Reduce surgical site infection (SSI) admission and readmission
• Adherence to process measures to prevent surgical site infection (SSI)
 2013 Targets and Progress Made by 2014

Original target for 2013

Measure (and data source) Progress made by 2014
(from 2009 baseline)
CLABSI (NHSN) 50% reduction 50% reduction
CAUTI (NHSN) 25% reduction No change
Invasive MRSA (NHSN) 50% reduction 36% reduction
Facility-onset MRSA
25% reduction 13% reduction
(NHSN)
CDI (NHSN) 30% reduction 8% reduction
SSI (NHSN) 25% reduction 18% reduction
Clostridium difficile
30% reduction 18% increase
hospitalizations (HCUP2)
 NEW TARGETS
Measure (and data source) 2020 Target (from 2015 baseline)
CLABSI (NHSN) 50% reduction
CAUTI (NHSN) 25% reduction
Invasive MRSA (NHSN) 50% reduction
Facility-onset MRSA (NHSN) 50% reduction
CDI (NHSN) 30% reduction
SSI (NHSN) 30% reduction

Clostridium difficile hospitalizations

30% reduction
(HCUP)

NHSN: The National Healthcare Safety Network, of the Centers for Disease Control and Prevention (CDC), is the nation’s most widely used
health care-associated infection tracking system. Since 2009, infection data has been reported to the NHSN to track the national
progress of the reduction of HAIs.
HCUP: AHRQ’s Healthcare Cost and Utilization Project is the nation’s most comprehensive source of hospital data. HCUP data is used to track
hospitalizations due to Clostridium difficile.
Fundamental Question

What role,
responsibilities,
and rights does
the patient have in
the HAI Prevention
Process?
Could this be Your Family Member?
What do these have in common?
Transmission of Infection
How Does Transmission Occur?

Patient

Environmental
Healthcare Worker
Surfaces
Patient Care
Equipment
How do you view mortality?
The Story Begins
 Hand Hygiene
• Significant numbers of HAIs could be
prevented if we practiced HH when indicated
 Adherence to infection control
guidelines is insufficient
 Many HAIs are preventable with current
recommendations, guidelines
 Failure to use proven interventions is unacceptable
 Only 30%-38% of U.S. hospitals are in full
compliance
 Just 40% of healthcare personnel adhere to hand
hygiene
 Insufficient infection control infrastructure in non-
acute care settings has allowed major lapses in safe
care
Where do you even begin?
The Story Continues
 DEFINITIVE HEALTHCARE
Powerful intelligence on hospitals, physicians and healthcare providers

“Why the Big Names in Healthcare Are Not Leaders in

Patient Satisfaction”
Top 10 Hospitals with 5 Star Patient Experience Ratings
• None over 50 beds or over 1800 discharges
• Size supports better nurse:patio ratios – improved
communication, discharge care instructions & response
frequency
• Lower noise levels at night
• Average HCAHPS ranged 85% - 92%
• Top Hospital Average 72 - 92%
• National average 52 – 87%
 DEFINITIVE HEALTHCARE
• If the highest satisfaction scores are almost
exclusively limited to smaller specialty
hospitals, what do the high scoring mid-to
large size hospitals look like? Top 10 ratings
• 504 – 1079 beds
• 21,177 – 43,121 discharges annually
• 58 – 89% top 10 hospital average
• 52 – 87% national average
HCAHPS Communication Measures
• Gave scores of 9 or 10
• “Strongly Agreed” that they understood care at
discharge
• Given recovery related information at discharge
• Always quiet at night
• Staff explained medicine before administering
• Pain always well controlled
• Always received help as quickly as wanted
• Doctors always communicated well
• Nurses always communicated well
 What are they doing differently?
1. They have made a concerted effort to
improve patient experience.
2. Baptist Medical Center (MS) was below
national average as late as 2014
1. Culture change emphasizing the responsibility of
ALL staff, rather than just the direct caregivers
2. Visible ongoing leadership from senior staff
 What are they doing differently?
• UAB (University of Alabama Birmingham)
• Largest number of discharges annually at 43,000+
Rated number 3
• Changed its business culture “UAB CARE”
– Involved all staff in the process
– Recognized the special role of the providers
– Created an Office of Patient Experience
– Engaged the physicians – educational tools, best practices

http://www.definitivehc.com/hospital-data/why-the-big-names-in-
healthcare-are-not-leaders
 What have we learned so far?
• HCAHPS results - smaller and larger hospitals
that are beating the national averages
– Smaller – issues/ratios are more manageable,
many are specialty hospitals
– Larger – concerted effort to improve patient care
• Business culture
• Everyone responsible, special emphasis on providers
• Physician input, tools, best practices
• Patient and/or family involvement
 What else?
IN AN ONGOING SURVEY WITH PATIENT
EXPERIENCE OFFICERS, A CONSULTING
FIRM FOUND THAT 50 PERCENT OF
HOSPITALS DO NOT MAKE AN ATTEMPT TO
GAUGE EXPERIENCE IN OTHER WAYS SUCH
AS PATIENT ADVISORY COUNCILS OR
SUPPLEMENTAL PATIENT SURVEYS.

IF HCAHPS ONLY, WHAT ARE YOU MISSING??

Is It Important to Include the Patient in
Prevention of Infection Transmission?

Patient

Environmental
Healthcare Worker
Surfaces
Patient Care
Equipment
 The Patient Empathy Project
What does the patient fear?
---- #1 FEAR INFECTION! -----------
----- Inconsiderate/rude doctors, nurses ----------
--------- Germs ------ Being forgotten -------
------- Death ----- Not asking the right questions --
------- Needles ------ Not understanding --------
---- Loneliness ------- Isolation ------
----------- Inconsistency -------------
www.sweeneyhealthcareenterprises.com
 External Pressures
Payment
Reform

Decreased
NHSN reimbursement

Accountable
Staffing
Care
Challenges
Organizations

Public Reporting
How Does Transmission Occur?

Patient

Environmental
Healthcare Worker
Surfaces
Patient Care
Equipment
Patient’s versus Nurse’s responses
to...
 Supporting the Patient’s Ability to
Address Their #1 Fear - Infection
1. WHAT Education re hand hygiene. When to do it,
why to do it, how to do it, product availability. Add
them to hand hygiene surveillance. Let them know.
2. WHO The patient, the family, the visitors, the
patient’s primary supporters
3. WHEN Pre admission, at time of admission, during
orientation to the room, when transferred to another
floor, before they’re discharged.
4. WHY Because infection prevention is everyone’s
responsibility – including the patient.
 Family Support
Psychologically beneficial in recovery

Primary Caregivers

Home Health Support

Patient Advocacy

Primary Caregiver Responsibility

Best Line of Defense

 Patient Education-Long Lost Art
• Patient Print-Outs at Time of Discharge
• What about an interactive approach to patient
and family education
– Signs and Symptoms of Infection
– Actions to Take if Suspected
– How to communicate concerns with your
healthcare provider
 2016 Hospital National Patient Safety Goals
The purpose of the National Patient Safety Goals is to improve patient safety.
The goals focus on problems in health care safety and how to solve them.

PREVENT INFECTION
• NPSG.07.01.01 Use the hand cleaning guidelines from the
Centers for Disease Control and Prevention or the World
Health Organization. Set goals for improving hand cleaning.
Use the goals to improve hand cleaning.
• NPSG.07.03.01 Use proven guidelines to prevent infections
that are difficult to treat.
• NPSG.07.04.01 Use proven guidelines to prevent infection
of the blood from central lines.
• NPSG.07.05.01 Use proven guidelines to prevent infection
after surgery.
• NPSG.07.06.01 Use proven guidelines to prevent infections
of the urinary tract that are caused by catheters.
www.jointcommission.org
Education for Both the Patient and Staff is
Necessary for Hand Hygiene SUCCESS!
• CDC recommendations for patients
– Before preparing or eating food
– Before touching eyes, nose or mouth
– Before and after changing wound
dressings/bandages
– After using the restroom
– After blowing the nose, coughing or sneezing
– After touching hospital surfaces such as bed rails,
bedside tables, doorknobs, remote controls, phone
 Infection Control and Hospital
Epidemiology August 2014, vol. 35, no. 8

SHEA/IDSA Practice Recommendation

Strategies to Prevent Healthcare-

Associated Infections through Hand
Hygiene
 Additional Recommendations
World Health Organization (WHO) recommends
that patients have access to hand hygiene
products if they have contact with their
wound(s) or the insertion site for a device.

The Joint Commission initiated the Speak Up

program to help patients become more
informed and involved in their healthcare.
Speak Up Campaign
On average, healthcare providers clean their hands less than
half of the times that they should. Alcohol based hand
sanitizer does not create antibiotic resistant superbugs.
Alcohol based hand sanitizers kill most of the bad germs that
make you sick. Alcohol based hand sanitizers do not kill C diff.

www.cdc.gov/handhygiene
 CLEAN HANDS COUNT
Know the TRUTH to protect yourself from serious infection.

• TRUTH
• Your hands can
spread germs.
• THE NITTY
GRITTY :
• Make sure you and your
visitors are cleaning your
hands at these important
times:
Antimicrobial Stewardship
Ten Steps for Safer Care-Part I

Ask if you still need a

Speak up Keep hands clean central line catheter or
urinary catheter

Ask your healthcare

provider, "will there be a
Be careful with
new needle, new syringe,
medications
and a new vial for this
procedure or injection?"
 Ten Steps for Safer Care-Part II

There are things you

Get Smart about can do to reduce your
Watch out for C. diff
antibiotics. risk of getting a
surgical site infection.

Know the signs and

Get your flu shot
symptoms of infection
 The need for HAI prevention research

Prevented
Healthcare-associated

 Need for complete

Infection

implementation of
Preventable practices known to
prevent HAIs

 Need for ongoing research

Prevention
Approach to identify new strategies
Unknown to prevent the remaining
HAIs
 Summary
• HCAHPS is just one piece of the puzzle.
• Patients and families need to be included and
are the last line of defense
• HCP should fully engage all of the care team
and family to serve as advocates
• When it doesn’t seem right-it most likely isn’t
• Infection Preventionists are subject matter
experts but unit-based expertise is needed
 Consumers Medical
Professionals
Public Health

Safe Healthcare is Everyone’s Responsibility

Patients Payors

Government
Healthcare
Facilities
 References
• Centers for Disease Control and Prevention, www.cdc.gov/hai;
www.cdc.gov/handhygiene
• The Joint Commission, 2016 National Patient Safety Goals.
www.jointcommission.org
• “Hand Hygiene: The Role of the Patient” Jane Kirk, GOJO.
• “Definitive Healthcare” www.definitivehe.com
• Colleen Sweeney sweeneyhealthcareenterprises.com
• The Joint Commission ‘Speak Up Initiative: Five Things You Can
Do to Prevent Infection’ (see above …/assets).
• “Preventing Hospital Infections: Real World Problems, Realistic
Solutions” Sanjay Saint et al. Oxford Publications 2015.
• Department of HHS 2020 HAI Action Plan.
• World Health Organization Hand Hygiene Guidelines (2009)
Guidance on Engaging Patients and Patient Organization in Hand
Hygiene Initiatives.