Patient Safety: Healthcare- Associated Infection

Quality Improvement Activities

For questions and comments, please contact:
Sarah Keehner,
RN, BSN, CNN
Quality Improvement Director
skeehner@nw1.esrd.net (203) 285-1214
 
Heather Camilleri, CCHT
Quality Improvement Coordinator
(203) 285-1224
ACTION REQUIRED:
Please be aware of the dates associated with each activity.

Registration Required: National Coordinating Center BSI QIA Learning and Action Network (LAN) Call
Tuesday, April  2, 2018 3:00 - 4:00 pm.   
 
Review:  Network BSI QIA Kick- Off call
 

January's National Coordinating Center BSI QIA Leaning and Action Network call recording

Click Here for Call Recording
 

Resources :
The CDC has established the Making Dialysis Safer for Patients Coalition to help educate staff and prevent patient form acquiring an infection.
 
Educational Tools:
Feedback:
Please take a moment to give us feedback regarding the resources below. Let us know if you believe these will be helpful in the facility and if patients utilize them.
Resource Assessment

Patient Safety
Dear Provider,
  
Thank you to the facilities in the Long Term Catheter (LTC) Reduction QIA who completed a root cause analysis for identified barriers associated removal of LTC in patients.  There will always be patients that require a catheter for treatment due to:
  1. Multiple failed fistula/grafts
  2. Patients being to ill to undergo fistula surgery
  3. Patient refusal
Identified barriers that the Network would like facilities to focus on to reduce the rate of LTC use are: 
  1. Patient missing appointment
  2. Patient education on preservation of fistula/graft
  3. Communication between the vascular surgeon office and the dialysis center

Every facility should appoints a Vascular Access Coordinator who can build a working relationship with the local vascular surgeon groups. This individual will also be responsible to tracking each patient with a LTC to determine where they are in the process of having a fistula placed.  
 
Dialysis patients are immunocompromised and have a greater risk of developing an infection. Dialysis patient have their bloodstream accessed at least three times a week, either during needle cannulation or central venous catheter connection.  Patients who dialyze using a central venues catheter are at an even greater risk for developing an infection. The Center for Disease Control and Prevention estimates that there were about 37,000 central venues catheter infections in 2008. For this reason, the Network is asking all facilities to audit any staff member who initiate or terminate dialysis treatment.

 
Each facility is being tasked with completing:
             *10 Catheter Connection Audits
             *10 Catheter Disconnection Audits
             *10 AVF/AVG Cannulationon Audits
             *10 AVF/AVG Decannulation Audits
All audits should be entered into NHSN by Friday, May 11, 2018.  
 
Each facility should have at least one staff member enroll and complete annual training in the National Healthcare Safety Network (NHSN). This will ensure that all bloodstream infections and any Dialysis Events are accurately documented in NHSN. Facilities should enter data in NHSN on a monthly basis. 
Project Activities

*Implement CDC core interventions

*Complete NHSN training

*Partner with the CDC Making Dialysis Safer Coalition

*Appoint a patient ambassador to help with patient audits

Long Term Catheter Reduction
Facilities who currently have a Long Term Catheter (LTC) in use rate greater than 15% are being tasked to reduce their LTC rates by 2%. Facilities with high LTC rates are being asked to appoint a vascular access coordinator and provide the Network with contact information for that person.
Project Activities

*Designate a vascular access coordinator

*Complete a Key Contact form for the facility  

Health Information Exchange  
A Health Information Exchange (HIE) platform is vital for communication between the dialysis facilities and the hospitals. A HIE will allow facilities to access patient information while they are still in the hospital and not rely on the hospital discharge planner or the medical records department to send patient level information to the facility after discharge from the hospital.
 
The Network has chosen Mass HIway as the HIE for facilities in this project to enroll in. For more information click the following link to get to Mass HIway Website. 

Independent facilities can enroll in an HIE on their own, but large dialysis organizations should speak with their corporations about the process of enrolling. 
We Want to Hear from YOU!
Please contact the Quality Improvement Department if you have questions, comments, or specific barriers that you would like to address.  Let us know if you have identified any best practices that you would like to share with the community.