Hospital-Acquired Infections at UNC Health Care

Last month, the Congress held a hearing to examine the financial and human impact of hospital-acquired infections (HAIs).

The main points raised in the hearing were:

¢ CDC estimates that there are approximately 1.7 million hospital-acquired infections resulting in 99,000 deaths each year.

¢ The financial costs of hospital-acquired infections are estimated to be extremely high. Extrapolated nationally, costs were estimated to be $46 billion.

Currently, there is no hospital reporting of nosocomial infections at the state level in North Carolina The rate of infection acquired at UNC Hospitals has remained stable for 15 years (2.6 percent 3.2 percent), although patient acuity with these infections has gone up. Because HAI rates are not collected nationally, these numbers cannot be benchmarked against nationally representative figures. However, we can compare them to the voluntarily collected data that enters the CDC's surveillance system we find that UNC's numbers for procedure-associated rates (e.g., central-line associated bacteremia, ventilator-associated pneumonia) are equal to or below the rates reported there. UNC is taking the initiative to address HAIs nonetheless, through three exemplary programs:

1) the Institute for Healthcare Improvement program
2) a hand hygiene improvement project
3) a central-line associated bacteremia improvement project

1) Three of the Institute for Healthcare Improvement's six quality improvement interventions specifically focus on preventing HAIs.

UNC is one of the more than 3000 hospitals participating in the 100,000 Lives Campaign. These hospitals commit to implementing some or all of six quality improvement changes. Three of these interventions are associated with HAIs:

¢ Prevent patients who are receiving medicines and fluids through central lines from developing infections by following five steps, including proper hand washing and cleaning the patient's skin with chlorhexidine (a type of antiseptic).

¢ Prevent patients undergoing surgery from developing infections by following a series of steps, including the timely administration of antibiotics.

¢ Prevent patients on ventilators from developing pneumonia by following four steps, including raising the head of the patient's bed between 30 and 45 degrees.

2) UNC's hand hygiene improvement project to prevent HAIs
Of the nearly two million health care associated infections that occur each year, a significant amount are preventable with good hand hygiene. According to UNC's Dr. Bill Rutala, if a hospital increases its compliance with CDC guidelines for hand hygiene, then it can reduce those infections.

Thirty-four published studies have monitored hand washing in medical institutions. The lowest rate of adherence to CDC guidelines was 5 percent, the highest was 81 percent. The next highest was 62 percent.

Since 2003, UNC has been trying to improve hand hygiene by adhering to the CDC guidelines. The goal was 80 percent compliance in its nine ICUs. UNC started at 50 percentin 4th quarter of 2003. In one quarter since then, the staff reached 80 percent adherence. Overall, UNC has been fluctuating around 70 percentadherence since the monitoring of this behavior began.

3) UNC's central line associated bacteremia improvement project
Since 1999 UNC has been trying to prevent central catheter-associated bloodstream infections through medical staff education, modifiying dressing kits, nursing education, and using custom insertion kits with an antimicrobial already placed in the catheter.

This concerted effort to eliminate and prevent hospital acquired infections at UNC is one more example of our efforts to lead the way in our quest for quality and patient safety. We have not finished the job, but we are making great progress.

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