Task Force for Reducing Hospital Acquired Infections Indicators and quality improvement

Transkript

1 Task Force for Indicators and quality improvement Nordisk Hygienkonferens Gøteborg september 2014 Bettina Lundgren, centerdirektør, dr. med. Formand for Region Hovedstadens Task Force for Halvering af hospitalserhvervede infektioner

2 11 hospitals 1.6 million inhabitants

3 Task Force for In the Capital Region of Denmark decided to reduce hospital acquired infections (HAI) by 50%. Task Force for More than 50 professionals (doctors, infection control nurses, QA-experts, datamanagers and pharmacists) are involved in the project organization Working groups within 8 specific areas: Bacteremia Ventilator associated pneumonias (VAP) Central Venous Catheter related infections (CVC-related infections) Surgical site infections (SSIs) MRSA Clostridium difficile Antibiotic use and bacterial resistence Urinary Tract Infections (UTIs)

4 Task Force for Surveillance in the Capital region and in Denmark National and international organisations Capital region - committee for infection control and Task Force Hospitals Infection control comities Clinicians Departments of Clinical Microbiology

5 Task Force for Organisation Committee for Infection Control and Hygiene, the Capital Region of Denmark Task Force for Reduction of Hospital acquired Infections Bacteremia VAP SSIs MRSA Antibiotic consumption & bacterial resistance UTIs CVCrelated infections Clostridium difficile

6 Task Force for LPR Landspatientregistret: Indlæggelser og udskrivelser Mikrobiologiske databaser - MADS - ADBakt EPM Elektronisk Patientmedicinering: Medicinforbrug DOMUS Postoperative sårinfektioner (Ortopædkirurgi) CIS Critical Information System: Patienter på intensive afdelinger (VAP) Kliniske kvalitetsdatabaser - Karbase

7 Task Force for News letter News Data Information Intranet: Data (monthly) Background What works

8 Task Force Halvering af infektioner Ventilator-associeret pneumoni (VAP) 20 VAP pr respiratordage 1. kvartal - 1. kvartal 2014 Intensive afdelinger, Region Hovedstaden Målsætning RH Multidisciplinær RH Neurointensiv RH Hjerteintensiv RH3163 (N/A) Hvidovre Hospital (til 30/4-) Bispebjerg Hospital Bornholms Hospital (N/A) Nordsjællands Hospital Gentofte Hospital Glostrup Hospital Herlev Hospital Målsætning Kommentarer: De 8 afdelinger, der har rapporteret data for 1. kvartal 2014 har haft i alt 8 VAP og mellem 0 og 6 VAP pr respiratordage. Ny afdeling er Hjerteintensiv på Rigshospitalet, der har registreret VAP siden 1. januar 2014.

9 Task Force Halvering af infektioner Postoperative sårinfektioner, Ortopædkirurgi Kirurgisk behandlingskrævende infektion efter primær knæalloplastik, kvartal Ortopædkirurgiske afdelinger, Region Hovedstaden 5,0% 4,0% 3,0% 2,0% 1,0% 2,3% 3,2% Ca pt/år får knæalloplastik Målsætning 1,1% 0,9% 1,0% 0,0% 2009 Kofidensinterval Reopereret pga. infektiøs komplikation Målsætning Kommentarer: Der var i 4.kvartal på 5 ortopædkirurgiske afdelinger i alt 5 kirurgisk behandlingskrævende postoperative sårinfektioner efter indsættelse af kunstigt knæ (knæalloplastik). Den samlede infektionsrate for perioden fra 2009 til 3. kvartal er 1,3 %. Infektionsraten har siden ligget omkring 1 %.

10 Clostridium difficile og Clostridium difficile 027 pr beddays Capital Region Amager Bispebjerg Bornholm Frederiksberg Gentofte Glostrup Herlev Hvidovre Nordhospitalerne Rigshospitalet Andelen af CD027

11 50 New cases of Clostridium difficile, Clostridium difficile 027 and Clostridium difficile-burden pr bed days Herlev Hospital CD 027 pr sengedage Nye tilfælde af CDI pr sengedage Burden pr sengedage

12 jan feb marts april maj juni juli august september oktober november december januar februar marts april jan feb marts april maj juni juli august september oktober november december januar februar marts april jan feb marts april maj juni juli august september oktober november december januar februar marts april jan feb marts april maj juni juli august september oktober november december januar februar marts april Task Force for Vancomycinresistant Enterococcus faecium (VRE) at four different hospitals Patients with VRE pr. month january april Rigshospitalet Herlev Hvidovre Bispebjerg Hospital

13 Task Force for Significant improvement has been identified VAP was reduced by 50% at 5/10 intensive care departments Patients with Clostridium difficile 027 were reduced by 77% on Herlev Hospital Clostridium difficile 027 was reduced by half on Bornholm hospital 28% less patients with Clostridium difficile 027 in the Capital Region

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15 A challenge to share experience! Task Force for

16 Task Force for Initiatives to reduce hospital acquired infections Hospital level Isolation cleaning team, Herlev, Hillerød Antibiotic stewardship, Herlev, Gentofte, Bispebjerg, Hillerød Data management, Herlev, Gentofte, Hvidovre, Bispebjerg, Hillerød E-learning on isolation, Bornholm Information on isolation for patients, Bornholm Regional level (Clostridium difficile) Use of chlorine disinfectant Fast diagnostics (PCR) Glosair (hydrogenperoxide) Use of antibiotics Working groups sharing knowledge

17 Task Force for Interventions and quality improvement Task Force network Best clinical practice Data management Local context and culture Leadership Sharing knowledge Education programs

18 Task Force for Acknowledgements Task Force Steering committee: Bettina Lundgren 1, Christian Østergaard Andersen 2, Jens Otto Jarløv 3, Helle Krogh Johansen 1, Jan Utzon 4, Monika Madsen 4, Jacob Anhøj 1, Jenny Dahl Knudsen 2, Rie Mikkelsen 2, Christian von Plessen 6, Annabel Krarup 2, Bente Olesen 4 Bacteremia working group: Christian Østergaard Andersen 2, Jenny Dahl Knudsen 2, Magnus Arpi 4, Mette Pinholt 4, Michael Tvede 1, Claus Moser 1, Ann Filippa Madsen 4, Steen Rasmussen 2 Ventilator associated pneumonia (VAP) working group: Jakob Steen Andersen 1, Inger Gillesberg 4, Morten Steensen 1, Asger Petersen 5, Dorte Buhl 4, Joakim Bay Simonsen 1 Central Venous Catheter (CVC)-related infection working group: Jens Otto Jarløv 4, Mette Østergaard 6, Torben Callesen 4, Jakob Steen Andersen 1, Leif Percival Andersen 1, Lisbeth Kyndi Bergen 1 Surgical Site Infection (SSI) working group: Annabel Krarup 2, Ole Michael Nielsen 1, Nini Møller 6, Anne-Marie Blok Hellesøe 1, Anne-Marie Thye 6 MRSA working group: Henrik Westh 2, Ina Sleimann Petersen 4, Heidi Meiniche 2, Mette Bartels 2, Kirsten Kristoffersen 2, Helle Neustrup 1, Steen Rasmussen 2 Clostridium difficile working group: Bente Olsen 4, Michael Tvede 1, Jette Bangsborg 2, Søren Thorsen 6, Anne Lester 2, Marie Stangerup 5, Jette Nygaard Jensen 4 Antibiotic consumption & bacterial resistance working group: Jenny Dahl Knudsen 2, Magnus Arpi 4, Stig Ejdrup Andersen 5, Helle Krogh Johansen 1, Barbara Holzknecht 4, Dennis Schrøder Hansen 4, Jannik Helweg-Larsen 1, Jette Houlind 8, Jonas Boel 4, Thor Schmidt 9, Jette Nygaard Jensen 4 Urinary Tract Infection (UTI) working group: Niels Frimodt-Møller 1, Jørgen Balslev Jørgensen 7, Dina Cortes 2, Leif Percival Andersen 1, Helle Neustrup 1, Steen Rasmussen 2 Hospitals in the Capital Region of Denmark: 1.Rigshospitalet, 2.Hvidovre Hospital, 3.Herlev Hospital, 4.KPUK, 5.Bispebjerg Hospital, 6.Nordsjællands Hospital, 7. Gentofte Hospital, 8. Frederiksberg Hospital, 9. IMT