Healthcare Safety Network Data Research Articles

Health care...associated infections studies project: An American Journal of Infection Control and National Health Care Safety Network data quality collaboration case study..÷Laboratory-identified event reporting validation

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of common surveillance concepts included in Laboratory-Identified (LabID) Event Reporting [Chapter 12 of the NHSN Patient Safety Manual - Multidrug-Resistant Organism &Clostridioides difficile Infection (MDRO/CDI) Module] used with validation efforts. The intent of the case study series is to foster standardized application of the NHSN surveillance definitions and encourage accurate event determination among Infection Preventionists (IPs).

774. Outbreak of Central-Line-Associated Bloodstream Infections (CLABSI) amid the COVID-19 Pandemic Associated with Changes in Central Line Dressing Care Accompanying Changes in Nursing Education, Nursing Documentation, and Dressing Supply Kits

BackgroundNational Healthcare Safety Network (NHSN) data have revealed an increase in CLABSI associated with the COVID-19 pandemic, but data on factors mediating the increase are limited. Our hospital had been free of CLABSI for 18 months, but we encountered an outbreak of 7 CLABSI over a 5-month period beginning in November 2020. This led to an investigation that revealed that some underlying issues were related to COVID-19.MethodsInfection prevention staff at Omaha’s Veterans Affairs Medical Center interviewed hospital staff and performed a retrospective chart review of patients with CLABSI (based on the NHSN definition) amid the COVID-19 pandemic.ResultsThe first case of CLABSI in the outbreak was detected in November 2020. Prior to that, there was no case of CLABSI since April 2019, as shown in the graph. Each case of CLABSI was associated with a different microorganism. Further investigation revealed deviations from our usual practices in central line dressing care. Our response to COVID-19 had included alterations in periodic competency training (including dressing care) for nursing staff as well as the rapid introduction of streamlined inpatient nursing documentation. Previously, dressing kits included chlorhexidine-impregnated dressings; in November, a kit without these dressings was introduced. A weekly audit of dressing care was begun in March 2021. No CLABSI was identified in April 2021.Types of Microorganisms identified Different types of microorganisms isolated during the CLABSI outbreak each month. The trend of CLABSI in VA Nebraska-Western Iowa Health Care SystemConclusionWe encountered a CLABSI outbreak associated with deviations from usual central line dressing care. Using the concept of the Swiss cheese model of error prevention, we recognized alterations in three barriers: competency training; thorough documentation; and complete supply kits. The first two of these factors were directly related to our COVID-19 response. Our findings illustrate the relevance of the Swiss cheese model for maintaining a safe healthcare environment.Disclosures Marvin J. Bittner, MD, Merck (Advisor or Review Panel member)Sanofi Pasteur (Speaker's Bureau)

Mandatory Pre-Authorization or “Hard Stop Order” to Decrease Inappropriate Testing for Clostridium difficile Infection. A Testing Stewardship at 2 Hospitals.

BACKGROUND Despite implementation of the Clostridium difficile Infection (CDI) algorithm in 2016, inappropriate testing remains an issue. To further reduce this problem, Mandatory Pre-Authorization (MPrA) or Hard Stop Order (HSO) was implemented in March 2017. MPrA/HSO requires the ordering physician to apply the criteria set in the algorithm and obtain approval from an Infectious Disease (ID) physician. The test is stopped if the criteria are not met and without approval. The objective of this review is to examine the effectiveness of the MPrA/HSO in our hospitals. METHODS An order set was built in the electronic medical record (EMR) identifying the ordering physician and ID attending approving the test. Educational sessions, posters and pocket size algorithm were provided. Orders without ID approval were referred back to the ordering physician or escalated to the Chief of Service or to the Director of Infection Prevention. Exclusion for the MPrA/HSO were Emergency Room patients suspected with CDI. National Healthcare Safety Network (NHSN) data from February 2016 to March 2018 were retrospectively analyzed. RESULTS Comparison of Pre and Post implementation data showed a decline of 68% in CDI testing for Hospital A and 61% for Hospital B. The Hospital-Onset CDI dipped to 74% in Hospital A and 61% in Hospital B and inappropriate testing decreased by 75% and 100% respectively. >97% met testing criteria and ID approval. Pre and Post MPrA/HSO Standard Infection Ratio (SIR) were statistically significant. CONCLUSIONS Testing stewardship accomplished a reduction of CDI testing without a corresponding increase in CDI, and without evidence of missed cases. Our goal of reducing inappropriate testing is achieved, thereby improving patient outcome as unnecessary isolation and exposure to antibiotics are avoided. Administrative support, interdisciplinary teamwork and integration of the MPrA/HSO in the EMR are essential in the success of this initiative.

Reducing Blood Stream Infections (BSIs) in Patients on Hemodialysis (HD)

ON HEMODIALYSIS (HD) Lynda Ball, Cheryl George, Nellie Hedrick, Lynda Osborn, Linda Duval, FMQAI Network 13, Oklahoma City, OK, USA Decreasing infections in the HD patient population is paramount to reduce morbidity and mortality. Network 13 initiated a quality improvement activity (QIA) to reduce BSIs in patients on HD. Key components of this QIA included: Monthly CDC audits; improving communication between patients and staff; and, education. Dialysis facilities were ranked utilizing 2013 National Healthcare Safety Network (NSHN) data. A minimum of 20% of the facilities with the highest BSI rates were chosen to participate. In addition, 20% of the Network 13 patient population (n=3175) was included to ascertain patient engagement in infection control practices. Facilities (n=63) were provided on-line orientation training, a reporting calendar, root cause analysis tools, educational resources (articles, posters, handouts, and on-line training) for patients and staff, CDC infection control audits for monitoring practice, and a patient-engagement checklist. Facilities reported progress monthly. The Network provided technical assistance for adverse reporting or as requested. Facilities were monitored the 2 and 3 quarter of 2014 for monthly BSIs and percentage of hand hygiene, catheter connect/disconnect, and cannulation audits correctly completed. Patient engagement with infection control practices were monitored at baseline, mid-point, and at the completion of the project. Results indicated a statistically significant (p<0.001) improvement in the reduction of BSIs (19.9% to 8.6%), and in increasing patient engagement in the infection control process (81.5% to 92.0%). CDC audits completed correctly included: Hand Hygiene baseline of 75.9% to a final of 92.4% (p<0.001); catheter connect/disconnect baseline of 90.2% to a final of 93.5% (NS); and, cannulation baseline of 78% to a final of 89.1% (p<0.05). The successful outcomes of this QIA suggest that this activity could be replicated and spread to meet the needs of the ESRD community as a whole.