Infection Prevention Initiatives
1. Unlimited Access to DICON Prevention Initiative on CA-UTIs
The Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals after October 1, 2008 for costs related to catheter-associated urinary tract infections (CA-UTI) if they are hospital acquired.
As many as 50% of CA-UTIs are preventable using inexpensive, “low tech” system controls. Unfortunately, most American hospitals have not instituted these simple controls. A recent nationwide survey of 771 hospitals disclosed the following disappointing results:
- 56% had NO system for monitoring patients with urinary catheters
- 74% did NOT monitor duration of catheter use
DICON has prepared educational materials that will help hospitals easily develop a simple, practical prevention program that will reduce the risk of CA-UTIs in patients in their hospital.
This initiative is focused on instituting three simple and basic “system controls” in the preexisting processes of care at hospitals. These three “system controls” include the following:
- A hospital-wide protocol for dealing with patients who cannot void.
- A hospital-wide protocol for assessing the continued need for a urinary catheter after one has been inserted.
- A comprehensive review and revision of pre- and postoperative order sets by individual surgical services to ensure that indications for urinary catheterization and routine orders for postoperative removal of catheters are clearly stated.
The DICON prevention initiative educational materials contain numerous specific documents and materials to help hospitals complete the three components listed above, including the following:
- Drafts of sample letters to be sent to medical staff members explaining the overall initiative, its specific components, and the scientific rationale and support
- Teaching aids (PowerPoint presentations) explaining the rationale as well as “nuts and bolts” of the protocols
- A “resource kit” containing key references that document the scientific evidence that supports the above program
This prevention initiative can simultaneously accomplish several key goals at a minimum cost:
- Reduce the risk and rate of CA-UTIs at hospitals (and thus save money)
- Improve patient safety at hospitals (and thus prevent harm to patients)
- Help change the culture in staff (i.e. help them understand and realize that hospital administration is committed to high quality and safe care).
2. Unlimited Access to DICON Prevention Initiative on Colorectal Surgery
The DICON Colorectal Surgery prevention initiative targeted colorectal surgeons and specifically focused on practical, simple, yet often overlooked measures that can reduce the risk of surgical site infections following colorectal surgery. Each surgeon in DICON hospitals received a “packet of materials” that included 1) an analysis of the risk factors for surgical site infections after colorectal surgery, 2) the rate of postoperative surgical site infections in their patient population compared to that of other colorectal surgeons and 3) well referenced suggestions on how to reduce the risk of postoperative infection in their patients (via using proper antimicrobial prophylaxis, weight-based dosing for obese patients and the value of intraoperative re-dosing of antimicrobial therapy when procedures exceed 3 hours in duration). In addition, each surgeon received a pocket guide for antimicrobial selection and dosing.
3. Unlimited Access to DICON Prevention Initiative on Clostridium difficile Infection (CDI)
This prevention initiative addresses the formidable problem of prevention of C. difficile infections (CDI) in hospitalized patients. This initiative includes practical system controls, protocols, recommendations and educational materials designed to systematically address the following common problems:
- Lack of focused and practical simple educational programs for housekeepers
- Lack of simple system controls to monitor the efficacy of cleaning patient rooms
- Lack of practical simple protocols for managing the infection control aspects of caring for patients with diarrhea;
i. When should diagnostic testing for CDI be ordered?
ii. What is/are the preferred diagnostic test(s) for CDI?
iii. Other issues (e.g. duration of isolation, presumptive isolation, cleaning protocols during hospitalization and after discharge)
- Lack of understanding of the role and efficacy of antibiotic stewardship programs in preventing CDI
- Lack of focused educational materials about CDI for medical and nursing staff
4. Any new Prevention Initiative prepared during the term of the agreement with the hospital acquiring a license from DICON
We plan to prepare two prevention initiatives every 15-18 months. In July 2011 we will begin working on the SSI Prevention Initiative that will have several components. One will be optimal skin prep prior to surgery. Another one will be infection prevention in the Operating Room setting. We anticipate we will complete the SSI prevention initiative and have it ready for distribution by Spring 2012.