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NUR 630 Benchmark – Hospital-Associated Infections Data

NUR 630 Benchmark – Hospital-Associated Infections Data

Presentation’s Outline

Regardless of size, resources, and other factors, health care facilities should consistently pursue high performance. Quality measures guide hospitals in evaluating performance and determining the scope and type of interventions required to enhance performance. The purpose of this presentation is to examine data related to hospital-acquired infection rates at ABC Health. Understanding this data and its implications is crucial for stakeholders to collaborate and define the desired goal for improvement. The main presentation areas include conclusions drawn for each measure, trends, and comparisons with the national benchmark. Other areas include an outline of priority quality measures, quality improvement metric, monitoring strategies, and using data for quality improvement.

Conclusions for SSIs from Colon Surgery (SSI: Colon)

In the current practice, surgical site infections (SSIs) continue to threaten patient safety and care quality. According to McFarland et al. (2023), SSIs are the second-most occurring hospital-associated infections after urinary tract infections. As displayed in this graph, SSI: colon rates rose sharply from 2012 to 2013 before increasing steadily from 2013 to 2015. Generally, there is a threatening increase in infection rates, posing a significant risk to patients undergoing colon surgery at ABC Health. Hou et al. (2020) reported that a single incidence of SSIs after surgery can double the danger of postoperative mortality. Therefore, multimodal interventions to prevent the rising infection rates for SSI colon are crucial in the facility.

Conclusions for CLABSI

Organizational leaders should know all issues hampering care quality and increasing facility management costs. Awareness of the rates of CLABSI can help them design effective control measures and reduce costs. As shown in the graph, CLABSI rates at ABC Health during the five years are somewhat within the same range (2.234, 2.089, 3.128, 3.063, and 3.422). Despite this performance, the goal should always be providing care without an incidence of HAI. This data could imply that the present interventions for controlling CLABSI are ineffective. Therefore, a change is necessary, but intervention designers and implementers should be effectively guided by data, scientific evidence, and priorities.

Conclusions for CAUTI

Hospitals should be safe sites for patients and care providers. A reliable way of achieving this goal is to implement measures to prevent HAIs as much as possible. CAUTI infection rates data for ABC Health is encouraging since it shows a consistent decline over the five years. Such a decline implies increased patient safety, more satisfaction, and other outcomes of reduced infection rates. Musco et al. (2022) suggested that most facilities rely on care bundles to prevent CAUTI, consisting of multiple interventions to address various clinical indicators. From the data on CAUTI at ABC Health, it can be deduced that measures used to prevent CAUTI from 2011 to 2015 were effective.

Conclusions for SSI: Hysterectomy

A facility recording high rates of surgical site infections from abdominal hysterectomy (SSI: Hysterectomy) should be worried about its procedures and the standard of the care environment. As the graph demonstrates, SSIs from abdominal hysterectomies at ABC Health increased steadily from 2011-2015 (1.148, 2.132, 2.094, 3.697, 4.608). Although there was an insignificant decline during the 2012-2013 period, overall data demonstrates a high-risk area since there has been no considerable decline over the years. Shigematsu et al. (2022) associated high infection rates after abdominal hysterectomy with prolonged operative time (lasting over 3 hours), excess blood loss, and the general condition of the patient. Therefore, examining these risk factors could help ABC Health to prevent further increases in the rates due to the resultant harm.

Trends Over the 5-Year Period

Hospitals should use quality measures to guide performance improvement. As the data shows, the rates for SSI colon have steadily increased in the past three years. CLABSI rates also reveal some increment in the same period, which is different for CAUTI, whose rates have declined. However, there is no data to allow a comprehensive analysis of CAUTI. SSI: hysterectomy rates are also on a gradual increment in the last three years. From these trends, it is obvious that risk factors that increase HAIs at ABC Health were high from 2013 to 2015. If not effectively controlled, there is a likelihood of recording similar or worse data after 2015.

Comparison with the National Benchmark: SSI Colon

Hospitals should always weigh their performance internally and externally. Willmington et al. (2022) underlined the importance of national benchmarks since they allow care facilities to identify their strengths and weaknesses at all system levels. Compared to the national benchmark, ABC Health did well from 2011 to 2013 since the infection rates were lower or equal to the national benchmark. Unfortunately, that was not the case in 2014 and 2015 since the rates were higher than the national benchmark, indicating a poorer performance than other facilities. As a result, intensified control measures are crucial in this area and others where infection rates exceed the national benchmark.

Comparison with the National Benchmark: CLABSI

CLABSI infection rates at ABC Health provide interesting figures compared to the national benchmarks. In 2011 and 2012, the hospital rates were worse than the national benchmark. In 2013, the rates were slightly better than the national benchmark before recording same figures in 2014 and 2015. On average, the rates are within the same range as the national benchmark, underscoring the need for intensified efforts to achieve a significant decline. Beville et al. (2021) advised health care professionals to consider reducing central line day by removing nonessential catheters, increasing multidisciplinary rounds, and other appropriate interventions. Similar measures are needed for the hospital rates to be lower than the national benchmark.

Comparison with the National Benchmark: CAUTI

CAUTIs increase health care costs and hospitalizations if not effectively controlled in care facilities. Compared to the national benchmark, CAUTI rates at ABC Health are better than the national benchmark over time. The reason being, the measure exceeded the national benchmark only in 2011 before equaling it in 2012 and recording a significant reduction in 2014 and 2015. Undeniably, a performance better than the national benchmark depends on the interventions a care facility uses to control infections. For CAUTI, the care bundle is widely used in many hospitals and has positive outcomes (Gupta et al., 2023). Therefore, ABC Health should continue with its CAUTI management strategies and integrate others that can lower the rates significantly.

Comparison with the National Benchmark: SSI Hysterectomy

Data provide an accurate reflection of hospital performance for stakeholders. On average, it can be deduced that ABC Health’s performance for SSI: hysterectomy is worse than the national benchmark over the years. This is because it only performed better than the national benchmark in 2011 before equaling it in 2012 and 2013. Next, the hospital’s performance declined in 2014 and 2015, indicating an increased risk for patients. Pangan et al. (2022) underlined the need for care facilities to implement the hysterectomy bundle to prevent SSIs from abdominal hysterectomy. Its essential components are chlorhexidine bathing and incisional skin preparation in the intraoperative phase and patient education in the post-operative phase.

Priority Quality Measures

Health care facilities prioritize intervention areas based on the severity of an issue, resources available, and evidence-based practice (EBP). After examining the data, priority quality measures should be SSI: colon and SSI: hysterectomy. As discussed in their respective sections, the rates for these measures have been increasing over time during the reference period. Besides, their average performance is worse than the national benchmark, indicating the need for rapid and sustainable interventions to control the current risk and mitigate future threats. Importantly, SSIs are critical outcome measures since they are effects of poor processes, such as long surgical hours, inadequate post-procedure hygiene, and poor orientation of nurses (Shigematsu et al., 2022; Tesfaye et al., 2022). Addressing them is crucial for higher outcomes in this facility.

Quality Improvement Metric and Related Measures

High patient outcomes are achieved through a concerted effort to address performance gaps. As Krishnappa et al. (2022) stated, health care professionals should work towards achieving specific goals within a particular timeline while using appropriate models. Doing so ensures effective utilization of health resources and performance tracking to facilitate adjustments as situations necessitate. Reducing SSI: hysterectomy is an appropriate quality improvement metric since it is specific, measurable, and time-bound. Apart from patient education, higher performance can be achieved by an incessant desire to promoting a safety culture, hand hygiene practices, and skin infection before and after procedures. Continuous vigilance of at-risk patients can also help ABC Health to respond to issues proactively.

Monitoring the Metric

Evidence-based interventions to address performance gaps are resource- and time-intensive. Therefore, implementers should monitor performance appropriately and modify the process as situations prompt. A patient education program for reducing SSI: hysterectomy can be effectively monitored progressively and at the end of the process. Progressive monitoring tools include checklists assessing whether everything progresses as planned. Patients can also be interviewed about their experiences with the intervention to evaluate its feasibility. Summative evaluation can provide reliable quantitative data about the effectiveness of the intervention. A suitable approach is a comparative analysis of the SSI: hysterectomy rates before and after patient education to determine whether the expected rate reduction was attained.

Using Data for Quality Improvement

Quality improvement is a continuous process focused on achieving better outcomes for patients, care providers, and health care facilities. According to Shah (2019), data helps nursing staff and leaders gain deeper insight into an issue and understand its meaning. Similarly, data from progressive and summative evaluations of the intervention can be useful in assessing its feasibility and identifying improvement areas. Data would also be helpful in evaluating the scope of future quality improvement programs, such as patient education and hand hygiene projects. Since some issues require multidimensional interventions, data is also essential in analyzing whether a single intervention or different programs are needed to address quality issues in the facility.

Summary

Quality improvement should be prioritized in health care facilities to optimize patient outcomes. The quality measures for ABC Health focus on HAIs, which significantly affect patient safety, care quality, and patient satisfaction. As graphically analyzed in the various sections, there is a threatening increase in rates for most measures except CAUTI. Therefore, ABC Health should prioritize some areas for immediate interventions. SSI: colon and SSI: hysterectomy should be the priority measures due to the increment in rates over the five years. The quality improvement metric (QIM) can be subjected to both progressive and summative monitoring to provide data for addressing performance gaps related to HAIs and other measures.

References

™Beville, A. S. M., Heipel, D., Vanhoozer, G., & Bailey, P. (2021). Reducing central line associated bloodstream infections (CLABSIs) by reducing central line days. Current Infectious Disease Reports23(12), 23. https://doi.org/10.1007/s11908-021-00767-w

™Gupta, P., Thomas, M., Mathews, L., Zacharia, N., Ibrahim, A. F., Garcia, M. L., … & El Hassan, M. (2023). Reducing catheter-associated urinary tract infections in the cardiac intensive care unit with a coordinated strategy and nursing staff empowerment. BMJ Open Quality12(2), e002214. http://dx.doi.org/10.1136/bmjoq-2022-002214

™Hou, T. Y., Gan, H. Q., Zhou, J. F., Gong, Y. J., Li, L. Y., Zhang, X. Q., … & Zhang, Y. (2020). Incidence of and risk factors for surgical site infection after colorectal surgery: a multiple-center prospective study of 3,663 consecutive patients in China. International Journal of Infectious Diseases96, 676-681. https://doi.org/10.1016/j.ijid.2020.05.124

™Krishnappa, V., George, E., Oravec, M., Jones, R., Lee, A., & Sweet, D. (2022). Quality improvement project to improve providers’ goal-setting activity for chronic disease self-management. Journal of Healthcare Quality Research37(2), 79–84. https://doi.org/10.1016/j.jhqr.2021.10.003

™McFarland, A., Manoukian, S., Mason, H., & Reilly, J. (2023). Impact of surgical-site infection on health utility values: a meta-analysis. British Journal of Surgery, znad144. https://doi.org/10.1093/bjs/znad144

™Beville, A. S. M., Heipel, D., Vanhoozer, G., & Bailey, P. (2021). Reducing central line associated bloodstream infections (CLABSIs) by reducing central line days. Current Infectious Disease Reports23(12), 23. https://doi.org/10.1007/s11908-021-00767-w

™Gupta, P., Thomas, M., Mathews, L., Zacharia, N., Ibrahim, A. F., Garcia, M. L., … & El Hassan, M. (2023). Reducing catheter-associated urinary tract infections in the cardiac intensive care unit with a coordinated strategy and nursing staff empowerment. BMJ Open Quality12(2), e002214. http://dx.doi.org/10.1136/bmjoq-2022-002214

™Hou, T. Y., Gan, H. Q., Zhou, J. F., Gong, Y. J., Li, L. Y., Zhang, X. Q., … & Zhang, Y. (2020). Incidence of and risk factors for surgical site infection after colorectal surgery: a multiple-center prospective study of 3,663 consecutive patients in China. International Journal of Infectious Diseases96, 676-681. https://doi.org/10.1016/j.ijid.2020.05.124

™Krishnappa, V., George, E., Oravec, M., Jones, R., Lee, A., & Sweet, D. (2022). Quality improvement project to improve providers’ goal-setting activity for chronic disease self-management. Journal of Healthcare Quality Research37(2), 79–84. https://doi.org/10.1016/j.jhqr.2021.10.003

™McFarland, A., Manoukian, S., Mason, H., & Reilly, J. (2023). Impact of surgical-site infection on health utility values: a meta-analysis. British Journal of Surgery, znad144. https://doi.org/10.1093/bjs/znad144

Introduction

qHAIs are complications in healthcare connected to high mortality and morbidity.
qAbout 1 out 25 patients in US are diagnosed with at least one infection related to hospital care.
qIncrease of these infections is definition of poor health care.
qWHO contend that the infections has risen from 3.5-12% in the recent past.
qThis presentation majors on four common HAIs.

Health-care associated infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia. The infections might also take place at the surgery sites called the surgical site infections. The increase of these infections defines a poor health outcome that hospitals need to attend to. Undeniably. World Health Organization reveals that the prevalence of HCAIs has jumped from 3.5% to 12% (Zepeda et al., 2021).  The prevalence is even high among the poor countrie

NUR 630 Benchmark  Hospital Associated Infections Data
NUR 630 Benchmark  Hospital Associated Infections Data

s. Healthcare-associated infections (HAIs) are complications of healthcare and linked with high morbidity and mortality. Each year, about 1 in 25 U.S. hospital patients is diagnosed with at least one infection related to hospital care alone; additional infections occur in other healthcare settings.

Healthcare Associated Infections  (HCAIs)

qIn this presentation, attention will be based on:
ØSurgical site infection from colon surgery (SSI: Colon
ØCentral line-associated blood stream infections (CLABSI)
ØCatheter-Associated Urinary Tract Infections (CAUTI)
ØSurgical Site Infection from abdominal hysterectomy (SSI: Hysterectomy)
qThese are data presented by a health hospital.

Healthcare-acquired infection is prevalent in many healthcare institutions across the world. The clinical and surgical procedures are linked to the increased cases of HCIs because of the increased rate of infection that accompany these surgeries (Zepeda et al., 2021).  The four common types of infection are Surgical Site Infection from colon surgery (SSI: Colon), Central line-associated blood stream infections (CLABSI), Catheter-Associated Urinary Tract Infections (CAUTI), Surgical Site Infection from abdominal hysterectomy (SSI: Hysterectomy). Surgical Site Infection from colon surgery is a type infection is among the most common types of surgical site infections. Central line-associated blood stream infections are preventable with proper management strategies, surveillance and aseptic techniques, they remain common. The Catheter-Associated Urinary Tract Infections which result when bacteria enter the bladder during a catheter use while Surgical Site Infection from abdominal hysterectomy is another type of common HCAI.

Managing Infections

qManaging infections reduces cost of health care
qIt also improved quality of life
qEffective disease management reduces complications on patients illness
qCoordinated interventions and health care efforts can be implemented in self-care options.

Disease management is the concept of reducing health care costs and improving quality of life for individuals with chronic conditions

NUR 630 Benchmark - Hospital-Associated Infections Data
NUR 630 Benchmark – Hospital-Associated Infections Data

by preventing or minimizing the effects of the disease through integrated care (Zepeda et al., 2021). Disease management programs are designed to improve the health of persons with chronic conditions and reduce associated costs from avoidable complications by identifying and treating chronic conditions more quickly and more effectively, thus slowing the progression of those diseases. It is a system of coordinated heath care interventions and communications for defined patient populations with conditions where self-care efforts can be implemented. People with chronic conditions usually use more health care services which often are not coordinated among providers, creating opportunities for overuse or underuse of medical care.

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Importance of Monitoring

qMonitoring patient data is important in the following ways:
qHelps doctors in prioritizing patients
qAssists in effective utilization of hospital resources
qHeightens care improvement process.
qEffective in monitoring patients with chronic infections

Patient data monitoring is an effective management system of infections. Data drives decision making process in healthcare especially in cases where there is an increased rate of infection among patients in healthcare.  Surveillance entails the collection, analysis and interpretation of patient data for various purposes. In HCAIs, surveillance and monitoring of the infection incidence rates (Noor et al., 2021). In monitoring data, early warning as well as infection problem investigation is possible. In monitoring of patient data, the stakeholders can prioritize the allocation of resources and evaluating the impact of specific interventions tailored towards solving a particular health problem. In addition, among the main reason for patient data monitoring is to gain information on the overall patient care quality.

Analysis of Quality Measures

qThe data from the facility shows evident trends on each quality measures observed.
qSSI: Colon showed an increasing trend.
qCLABSI also showed a general inclining trend.
qCAUTI showed a decreasing trend
qSSI: hysterectomy has a general increasing trend.

The data on ABC health hospital, relays more information on a particular trend that each quality measure was showing through the years. The national benchmark is important in the comparison of the quality measures and prioritizing which measures is more significant compared to the other.  Besides, its shows whether ABC hospital is complying with the national requirements or not. SSI: Colon was the first measure with values above the national benchmark for two last years, 2014 and 2015 (Noor et al., 2021). In the years 2013, SSI: Colon had a score of 2.219 which equalled national benchmark. In 2011 and 2012, SSI: Colon score was below the national benchmark with a 0.273 and 0.174 against 2.234 and 2.136 respectively. CLABSI scores were generally above or equal to the national benchmark within the five years. However, there was a change in 2013 where the score was 3.062 against the national benchmark of 3.128. CAUTI scores were generally below the national benchmark with the first year showing a slight deviation a score higher than the national benchmark.  The last measure, SSI: Hysterectomy has a general trend increasingly higher than the national benchmark.

Prioritizing Quality Measure

qThe four quality measures defined by the data have varying trends .
qFor example;
vCAUTI shows a declining trend that defines increased quality.
vSSI: hysterectomy has a poor trend which raises alarm.
v CLABSI, SSI: Colon and SSI: hysterectomy has a value higher than the benchmark score.

The quality measures are compared to the benchmark scores. The national benchmark scores always come from performing States. In some cases, a lower score could be interpreted as positive while in other cases a lower score could be interpreted as a negative score.  Scores like the mortality and infection rates need to have a lower score as a positive outcome. On the other hand, higher values are needed for measures such as vaccination rates (Noor et al., 2021). In this case, lower scores will be required for the four measures. In this data, the only measure that has a direct interpretation is the CAUTI. The remaining three measures have scores above the national benchmark and an inclining trend.

Quality Improvement Metrics: Care Process

qHAIs are a threat to human safety and there is need undertake effective care process.
qCare process should include;
qPublic health surveillance
qAntibiotic stewardship
qHand Hygiene
qScreening and regrouping patients

Healthcare-associated infections (HAI) are a threat to patient safety. CDC provides national leadership in surveillance, outbreak investigations, laboratory research, and prevention of healthcare-associated infections. CDC uses knowledge gained through these activities to detect infections and develop new strategies to prevent healthcare-associated infections. Care process for SSI: Colon and CLABSI needs quality improvement metrics. This process has a direct impact on measured outcomes by ensuring that the changes implemented are significant in achieving a positive patient outcome. For instance, the caring for surgical site infections implies that the resulting would need effective care that would lower the rate of infections. The other quality metric for improving the care process in enhancing self-hygiene after the surgery.

Quality Improvement Metrics: Outcomes

qAccording to the health data, there are measures that needs to be developed to achieved the desires quality outcome. For example;
qSurgical site infection score should be show progressive reduction that reveal a declining trend.
qThe   CLABSI should be below the national benchmark.
qThe SSIs should as well be below the national benchmark

The outcomes of SSIs and CLABSI need to be improved such that they show scores below national benchmark. Outcome measures ae meant to show that the measures taken to solve a particular clinical issue is showing positive sign on the improvement. It therefore articulates the picture of success. From the data analysis, it was evident that the surgical site infection and CLABSI has scores which are higher above the national benchmark, revealing that the ABC health hospital is performing poorly when it comes to these measures (Noor et al., 2021). For instance, ensuring that surgical site infections score is 95% and above, this will ensure that that rates are well within the acceptable ranges.

For this prompt, the hospital survey was utilizing to assess the subjective analysis on how well the organization does in regard to patient safety (AHRQ, n.d.). Upon completing the survey the final score was 21.9% negative, 28.1% neutral, and 50% positive. The facility obtained the highest positive scores in the supervisor, manager, clinical leader support for patient safety category. The lowest negative scores were seen in the staffing and work pace category. It is important to encourage continued success when a category is highly praised. Continuing to foster a culture of safety by reinforcing positive leadership behaviors will ensure that this category sustains its high marks. Encouraging supervisors, managers, and clinical leaders to maintain their support for patient safety initiatives and regularly communicate their commitment to staff, will result in continued positive team leading abilities. A few ways to encourage this maintenance would be recognizing and developing reward programs for excellent leadership abilities. As for the negative staffing level category, Evaluation of current staffing levels across various departments and units is essential. If the survey results suggest that staffing is insufficient, then consider adjusting staffing ratios to ensure that workload is manageable and safe for both patients and staff (Griffiths et al., 2020). There are various tools and approaches to this task that may be successful (e.g., volume-based, patient acuity measurements, and time-tasked) to name a few (Griffiths et al., 2020). One such tool is called the Safer Nursing Care tool which emphasizes measuring the appropriate ratios and workload to determine staffing to support safe patient care (Griffiths et al., 2020). Conducting these workload assessments to identify areas of high demand and implementing strategies to address them might require redistributing tasks, adjusting shift schedules, or employing temporary staff to meet demand.