Preventing Total Hip and Total Knee Surgical Site Infections in a Multi-hospital System through Numerous Interventions Including Standardized Infection Ratios

Abstract

completed the collaborative which ran September 2010-December 2011. The 16 facilities encompassed 44 reporting units including 19 critical care, 5 step-down, 19 wards, and 1 specialty care area. Requirements included establishing/maintaining multidisciplinary project teams, completing a pre/post-assessment, implementing the Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of CAUTIs, reviewingprogressmonthlywith project team and staff, and participate in site visits, live training, and monthly collaboration calls. Additionally, facilities reported all CAUTI events in participating units via the National Healthcare Safety Network (NHSN). All CAUTI event data was collected via the NHSN user group function, analyzed using the NHSN statistical calculator, and presented only in aggregate format for confidentiality purposes. RESULTS: The pre/post-assessment identified 3 major improvements participants made over the course of the collaborative. The proportion of facilities that had a procedure for daily assessment increased from 64% to 85%, those that provided regular training to staff increased from 57% to 85%, and those that used alternatives to indwelling catheters increased from 57% to 85%. Overall, both the CAUTI rate and the DUR remained fairly stable during the collaborative. While there was no significant decrease in the CAUTI rate when comparing the baseline period (October 2010 e March 2011) to outcome period (July 2011 e December 2011), the DUR decreased from 0.39 during the baseline period to 0.38 during the outcome period, a 3.8 % reduction (p<0.005). CONCLUSIONS: The results of the collaborative reflect that a comprehensive approach to CAUTI prevention as highlighted in the HICPAC guideline may reduce the DUR. Limitations of data include aggregate reporting which may mask significant changes, and the 15 month collaborative period which does not provide sufficient data points to reliably and validly identify special cause variation. The collaborative has been continued with a second cohort which includes 50% of original participants, giving these facilities 27 data points to analyze.