Reduction of Healthcare-Associated Infections (HAIs) by 83% in a long-term acute care setting (LTAC)

Abstract

BACKGROUND HAIs impose significant patient safety consequences. LTACs provide extended medical and rehabilitative care to patients with clinically complex problems. LTAC patients have an average of three to six concurrent active diagnoses and multiple acute complexities with a 28?day average length of stay. Our objectives were to reduce HAI rates through process improvement. METHODS We focused on prevention bundles to reduce HAIs. Catheter?-associated urinary track infection (CAUTI) bundle included nurse-driven urinary catheter removal and hand hygiene protocols. Clostridium difficile infection (CDI) bundle included hand hygiene, personal protective equipment and transportation protocols, preemptive isolation and antibiotic stewardship. Central line-associated bloodstream infection (CLABSI) bundle included nurse-driven device removal and hand hygiene protocols. HAI champions served as role models for change through education and audits. RESULTS These implementations created change in our facility that decreased HAIs from 53 in 2013 to 9 in 2018. The CAUTI rate decreased from 5.4 per 1,000 line days (31 CAUTIs) to 1.8 (3 CAUTIs), SIR= 0.697. The incidence density rate (IDR) p-value was 0.0085. The urinary catheter line days decreased 61.6% from 5765 to 2213. The CDI rate decreased from 14.4 per 10,000 patient days (15 CDIs) to 4.1 (3 CDIs), SIR= 0.370. The IDR p-value was 0.0312. The CLABSI rate decreased from 1.04 per 1000 line days (7 CLABSIs) to 0.59 (2 CLABSIs), SIR= 0.296. The IDR p-value was 0.0312. The central line days decreased 49.8% from 6709 to 3367. Hand hygiene compliance increased 45% from 62% compliance to 90% compliance. CONCLUSIONS HAIs are a major concern in the LTAC setting. Focusing on prevention of HAIs was effective in reducing our rate by 83% with a significance level of p=0.0001. Although statistical significance was not reached, the reduction in HAIs was significant for our patients. HAIs impose significant patient safety consequences. LTACs provide extended medical and rehabilitative care to patients with clinically complex problems. LTAC patients have an average of three to six concurrent active diagnoses and multiple acute complexities with a 28?day average length of stay. Our objectives were to reduce HAI rates through process improvement. We focused on prevention bundles to reduce HAIs. Catheter?-associated urinary track infection (CAUTI) bundle included nurse-driven urinary catheter removal and hand hygiene protocols. Clostridium difficile infection (CDI) bundle included hand hygiene, personal protective equipment and transportation protocols, preemptive isolation and antibiotic stewardship. Central line-associated bloodstream infection (CLABSI) bundle included nurse-driven device removal and hand hygiene protocols. HAI champions served as role models for change through education and audits. These implementations created change in our facility that decreased HAIs from 53 in 2013 to 9 in 2018. The CAUTI rate decreased from 5.4 per 1,000 line days (31 CAUTIs) to 1.8 (3 CAUTIs), SIR= 0.697. The incidence density rate (IDR) p-value was 0.0085. The urinary catheter line days decreased 61.6% from 5765 to 2213. The CDI rate decreased from 14.4 per 10,000 patient days (15 CDIs) to 4.1 (3 CDIs), SIR= 0.370. The IDR p-value was 0.0312. The CLABSI rate decreased from 1.04 per 1000 line days (7 CLABSIs) to 0.59 (2 CLABSIs), SIR= 0.296. The IDR p-value was 0.0312. The central line days decreased 49.8% from 6709 to 3367. Hand hygiene compliance increased 45% from 62% compliance to 90% compliance. HAIs are a major concern in the LTAC setting. Focusing on prevention of HAIs was effective in reducing our rate by 83% with a significance level of p=0.0001. Although statistical significance was not reached, the reduction in HAIs was significant for our patients.