Can we get to zero

16-11-15

1

International Society of Chemotherapy for Infection and Cancer

www.ischemo.org

16-11-15

2

PeoplewhosaythatzeroHAIsarepossible…¤ RedefinedHAIs

² CLABSI=2setsofbloodculturesandFpwithgenoFpicallyidenFcalpathogenandbloodculturedrawn(notviathecatheter)negaFve

¤ UsemeanstaFsFcalmethodse.g.“median”¤ PeoplewhohaveneverseenahospitalfromtheinsideandmakewildassumpFons

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3

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4

Swisscheeseaccidentmodel

Swisscheeseaccidentmodel

Handhygiene

AnFbioFcmisuse

Lackingskills

Understaffing

Crosstransmission

Badluck

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5

Handhygiene

AnFbioFcmisuse

Lackingskills

Understaffing

Crosstransmission

Badluck

NI

outbreak

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6

BIG-FAT

Guide

line

EvenbeUerGuideline

VerylongsuperGuideline

LocalRecommendaFon

NaF

onalRecom

men

daFo

n

TinyoverlookedGuideline

RecommendaFon

MoreRecom

mendaFon

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7

Fasces=bundle=strength

¤ AbundleisastructuredwayofimprovingtheprocessesofcareandpaFentoutcome

² asmallsetofevidence-basedpracFces² generallythreetofive² performedcollecFvelyandreliably

¤ ProventoimprovepaFentoutcomes

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² Evidencebased

² AchievableinallpaFents

² Covertherelevantaspectsoftheprocedure

Evidencebased

Coverrelevan

taspects

Achievab

leinallpa

?ents

¤ Createacultureofsafety¤ CreateamulF-disciplinaryimprovementteam¤ Ensurefullcommitmentwiththebundleelements² NomorediscussionsabouttheeffecFvenessofthebundleelementsoncestarted

¤ Agreeuponthelengthoftheimprovementperiodandlevelofadherencewithmeasures² IfthatisnotpossibleàDon’tstart!

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9

1 2 3 4 5 6 7 8 Elementcompliance

Element1 Y Y N Y Y Y Y Y 87.5%

Element2 Y N Y N Y Y Y Y 75%

Element3 N Y Y Y Y Y N Y 75%

Element4 Y Y Y Y Y N Y Y 87.5%

Element5 Y Y Y Y Y Y Y N 87.5%

PaFents/procedures

BundleCompliance 12.5%

Surgical Site Infections

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10

Noinfluencepossible

¤  Age

¤  Underlyingdisease

¤  Malignancy

¤  WoundclassificaFon

¤  ProstheFcmaterial

Influence not probable •  Laminarair-flow•  SterilizaFon•  Pre-op hospitalization

Influence by others

•  BMI >30

•  Nicotine use

•  Malnutrition

•  Infection at remote site

Can & should be influenced

•  Surveillance

•  S. aureus colonization

•  Normothermia/hyperoxia

•  Glucose levels

•  Hair-removal

•  Antimicrobial prophylaxis

•  Skin disinfection/decolonization

¤ Hairremoval

¤ AnFmicrobialprophylaxis

¤ Normothermia

¤ DisciplinintheOR?

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BundleCompliance

SSIRate

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¤ Builtimprovementteam(A-team)

¤ SelectintervenFons¤ Implementinter-venFons

¤ CheckcompliancewithintervenFons

¤ Checkoutcome

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14

PhamD

ClinMicro/ID

ICT

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¤ Control/restrictuseofreserve-anFbioFcs¤ SelectandmeasureindicatorsforadequateanFmicrobialuse

¤ Standardizeempirictreatmentandfosteriv-oralswitch

¤ EducaFonandtrainingwithregardtoanFmicrobialuse

¤ DefineallpaFentscategoriesthatneedbed-sideIDconsultaFon

Control/restrictuseofreserve-an?bio?cs.¤ An$bio$cguideline¤ ChecksbyA-team¤ Automa$creportsonDDD’sper1000pat-days¤ Pre-useauthoriza$on¤ Restric$verepor$ng

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Selectandmeasureindicatorsforadequatean?microbialuse.¤ Check“useaccordingtoguideline”by

² point-prevalencestudies² dailyconsulta$ons² audits

Standardizeempirictreatmentandfosteriv-oralswitch.¤ On-lineAB-guideline¤ “5xS”aspartofconsulta$on&teaching

² start,safety,streamline,switch,stop

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Educa?onandtrainingwithregardtoan?microbialuse¤ Con$nuouseffortofID&ClinMicro

² ownfellows² partofhospitalfelloweduca$on² partofrounds² “switchoftheweek”

Defineallpa?entscategoriesthatneedbed-sideIDconsulta?on¤ Allpa$entswithmeningi$s,endocardi$s,usingan$bio$csforlongerthan2weeks,sufferinganS.aureusbacteremia,andreceivingreservean$bio$csareseenatbed-sidebyID/CM

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¤ Real-Fmesurveillance(includingfeedback)oflocalresistancetrendsandresistancerelatedproblemsintheregion/country

¤ AnFbioFc/treatmentguidelines¤ InfecFoncontrolguidelines¤ NaFonalorregionalresistancesurveillance¤ NaFonalorregionalHAIsurveillance¤ AnFmicrobialusesurveillance¤ Auditsbasedonprofessionalstandards(IGZ)¤ CM/ICP/IDspecialistsinallmajorhealthcaresenngsandregionalco-operaFon