3 Ways to Decrease Nosocomial Infections in Hospitals

Two costly, yet preventable nosocomial infections are central-line associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Yet, despite the preventability of the majority of CLABIs and CAUTIs, health systems, payers, providers, and patients spend enormous amounts each year to treat them. For example, each CLABSI case costs an estimated $20,000 — an avoidable cost if hospitals and care providers use the right approach and tools.

Nosocomial infections also decrease patient satisfaction and increase the risk of a financial penalty for hospitals that have higher rates of infection than peer health systems under the government Hospital-Acquired Conditions (HAC) Reduction Program. But there’s good news: if hospitals and health systems strategically prioritize the reduction of nosocomial infections as a goal, they can greatly improve nosocomial outcomes. Here are three ways to decrease nosocomial infections.

1 — Use an EDW to Reduce Wasted Tracking Time

In a typical hospital environment, infection prevention teams spend many hours manually tracking blood and urine culture results. The teams also review clinical data, such as the presence of fever for patients with central line or urinary catheters, to identify patient populations who’ve acquired nosocomial infections during their hospital stay. Yet, even after the teams identify the nosocomial infections, they must continue to track these patients to comply with internal and external reporting measures. Because of this time-intensive approach to tracking, infection preventionists are not able to spend their valuable time doing what they do best — working to prevent infections.

A Late-Binding™ enterprise data warehouse (EDW), however, reduces the need for teams to manually track patients who’ve received a central line or urinary catheter as part of their treatment. By using the near real-time data and visualizations a Late-Binding™ EDW offers, infection preventionists can quickly review automatically generated, easy-to-read reports to identify actual infection rates. Then they can focus on education, clinical interventions for hand hygiene and sterile techniques for placement of catheters, and analysis of at-risk patients to provide further prevention strategies.

For example, one large health system, North Memorial, reduced their CLABSI and CAUTI surveillance activities by 90 percent by using an EDW along with Health Catalyst’s advanced analytics application tool. The analytics tool provided Centers for Disease Control and Prevention (CDC) standard NHSN (National Healthcare Safety Network) metrics along with other metrics and easy-to-understand visualizations of the health system’s CLABSI and CAUTI data. With these metrics and visualizations, the infection preventionists could measure the impact of their interventions and help measure, accelerate, and sustain improvements. In addition, EDW-enabled algorithms made it possible to identify cases previously missed with traditional surveillance approaches. As a result, North Memorial increased their ability to accurately identify hospital-acquired infection (HAI) cases and to provide interventions and treatments to increase patient safety while decreasing HAI rates.

North Memorial now plans to expand their goals to reduce CAUTI rates in the ICU by 25 percent  — a significant amount. Once the analysts compare and validate the data against the results of chart review by infection preventionists, they will roll out the solution to all units in their organization.

2 — Create a Data-Driven Culture of Commitment

Technology by itself can’t decrease nosocomial infections. The culture of the health system must be dedicated to driving change by using quality data to improve outcomes. Commitment to changing the culture must start with hospital leaders, physicians, and clinicians. In particular, Infection Prevention leadership must be committed to pulling together a multidisciplinary team of infection preventionists, clinicians, and experts from finance and quality who will work together ensure compliance with best practices and who are committed to eliminate CLABSIs and CAUTIs.

For example, a large medical center needed to streamline its process for identifying patients with CLABSI and CAUTI to comply with increased HAI reporting requirements. They formed a multi-disciplinary team to evaluate the hospital’s quality measures, identify HAI opportunities for improvement, revise the EDW’s algorithms, and to develop easy-to-understand visualizations. Previous attempts like this one were temporary, but after deploying a Late-Binding™ data warehouse and creating a data-driven culture, this team continues to meet on a monthly basis to ensure their clinical improvement gains will be sustained. In addition, they’re now evaluating opportunities to expand their improvement goals into additional care process families such as septicemia.

3 — Manage the Data on an Enterprise Level

Establishing consistency on an enterprise level is difficult, especially since many health systems traditionally use inconsistent definitions, measurements, and reports. Despite the challenge, however, health systems must find a way to comply with measurement and reporting requirements for infection prevention measures mandated by the National Healthcare Safety Network (NHSN) and Centers for Medicare and Medicaid Services (CMS) — or face significant financial penalties.

With sophisticated analytics, however, built on top of an EDW, health systems can quickly (a few months as opposed to a few years) begin to track their CAUTI patients across the system. For example, North Memorial invested in a Late-Binding™ EDW when it expanded to a second hospital in 2010. By using the EDW to pull in disparate sources of data from its existing electronic health record (EHR) along with a Patient Injury Advanced Application-CAUTI Module, they successfully began to manage and leverage the data on an enterprise level.

After a mere 10 weeks from start of the project, teams from North Memorial were running their first reports. Now they are successfully applying consistent definitions, measuring more efficiently, and have confidence across the enterprise that their reports to NHSN are accurate and consistent.

Nosocomial infections

This image shows sample visualization from a Health Catalyst CAUTI Advanced Application. The green line shows consistent hand hygiene compliance and the blue line shows a fluctuating CAUTI rate per 1,000 urinary catheter days

Don’t Wait – Start Now to Reduce Nosocomial Infections

CAUTIs and CLABSIs are avoidable causes of waste. These preventable infections increase the risk of mortality, length of stay, and cost; and they decrease patient satisfaction. Health systems need to start now to decrease nosocomial infections and to avoid payment penalties from CMS. By leveraging advanced analytics and an EDW platform, health systems will be able to successfully reduce nosocomial infections and efficiently measure, report, and maintain the improvements across the entire enterprise.

What have you done to decrease nosocomial infections at your hospital? Have you had success limiting CAUTI and CLABSI infection rates at your health system?  If so, what helped you achieve your goals?




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