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Linzie Gatchell

on 25 November 2013

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Transcript of NDNQI

Nosocomial Infections
Group Members: Linzie Gatchell (gatcla02@students.ipfw.edu), Kayla Smith (smitkm12@students.ipfw.edu), Chidimma Nwankwo(nwancn01@students.ipfw.edu),

-CAUTI's lead to longer hospital stays which in turn cost more money.

-CAUTI is the leading cause of secondary bloodstream infections.

Nosocomial Pneumonia
-Nosocomial pneumonia is contracted from an infection that is obtained in the hospital. Also called hospital acquired pneumonia (HAP).
Causes of CAUTI's
-The duration of the catheter is the most important risk factor for development of infection.
-Additional risk factors include: female sex, older age, and not maintaining a closed drainage system.

Ways to improve/prevent CAUTI
-Limiting catheter use unless completely necessary.

-Minimize the duration of length of time that the catheter must stay in patient.
- catheter-associated urinary tract infections (CAUTI's) are caused by bacteria that has entered the urinary tract during a catheter insertion, through the catheter tube, or the catheter's external surface.
Causes of Nosocomial Pneumonia
-Occurs in people 48 hours or more after being hospitalized for another condition.

-People who are on ventilators which are often used in intensive care units, are at higher risk for this type of pneumonia.
Problems Identified
-The main problem with nosocomial pneumonia is longer hospital stays and possibly even death if it is a vented patient and they develop respiratory depression.

-These vented patients are at higher risk of not being able to be taken off the vent.
Ways to prevent
-Staff education on infection and micro surveillance.
-Prevent aspiration and suction respiratory secretions.
-Excellent trach care, oxygen humidifiers, and standard precautions for everyone.
What not to do!
Central Line Infections
-Positive blood culture in a patient who had a central line at time of infection or or within the 48-hour period before development of infection (Meddings, Reichert, Rogers, Saint, Stephansky, & McMahon, 2012; O’Grady, Alexander, Burns, Dellinger, Garland, Heard, …HICPAC, 2011)

-This is LARGELY preventable
Problems Identified
Central line infections can cause:
longer hospital stays
longer recovery period
unnecessary illnesses
reimbursement issues
Ways to improve
Review of policies
-Proper handling
-Assess nurse knowledge of care for patients with central lines
-Site checks
Follow CDC guidelines and best practice (O’Grady, Alexander, Burns, Dellinger, Garland, Heard, …HICPAC, 2011)
-2% chlorhexidine wash
-Speak up when practices aren't followed
-Recognition for those that follow best practice
-Hand hygiene/gloves
-"Scrub the hub"

Reimbursement Implications
-Coding issues
-Hospital-acquired conditions initiative "No Pay Rule" by the Center of Medicare and Medicaid services (CMS)
-"Three strike rule"

Effect on Healthcare facilities
-Complex coding allows for repayment
-HCAPS scores
-Insurance policy coverage

Effects on Nursing
-Need lessened patient acuity
-Staffing needs
-More meticulous care
-Reteaching basic skills
-Effect on pay (bonuses/benefits)

Ways to improve
-Strict monitoring of coding system
-Primary prevention measures
-Less acuity/more staff

Nocosomial Infections
"What are they, Who is at risk, and how do we prevent them"
Nosocomial infections are infections that originate or occur in the hospital
Patients at risk
The very elderly &
The very young
80,000 occurences in ICU's each year (Kusek, 2012)
12-25% of cases are fatal (Harnage, 2012; Vital Signs, 2011)
A single CLABSI costs $16,550 (Hospital Infection Control & Prevention, 2011)
37,000 CLABSI's were reported occurred in outpatient hemodialysis patients in 2008 (Vital Signs, 2011)
Reductions in CLABSI's has saved 3,000-6,000 lives and $414 million in 2009 alone (Vital Signs, 2011)
Our goal is to provide future nurses with information about specific nosocomial infections, their implications on the patient, and ways to improve or prevent and increase patient outcomes.
-Nosocomial pneumonia is the second most frequent cause of hospital-acquired infection in the United States (Cellis, Torres, et al; 2010)

-36.6% of patients admitted to the hospital acquire pneumonia that was hospital acquired(Cellis, Torres, et al; 2010).

-66.7% of those patients were from an ICU, 24.2% medical, and 9.1% surgical(Cellis, Torres, et al; 2010).

-The fatality rate among patients who developed pneumonia while being in an ICU was 50% whether or not they developed respiratory failure (Kollef, 2011).
-Turn bed rest patients
every 2 hours as
Catching Nosocomial Pneumonia Early
-Clinical signs of infection: new onset fever, leukocytes, and tachypnea combined with purulent respiratory secretions, new auscultation findings and the presence of opacity on the radiology review x-ray (Myrianthefs, Kalafati, Samara, & Baltopoulos 2004).
Possible Causes
-Improper insertion
-Improper cleansing
-Improper use/maintenance
Problems identified from CAUTI's
Urinary tract infections (UTI) are the most common type of Hospital acquired infection (HAI).

-80% of UTIs are estimated to be catheter associated.

>30% of HAIs are reported, comprising an estimated 560,000 infections annually.

Problems identified continues.....
Some recommendations
from CDC, NHS Epic project 2001 and 2007
-Ensure documentation of catheter insertion
-Ensure that trained personnel insert catheter
-Train patients and family
-Practice hand hygiene
-Evaluate necessity of catheterization
-Evaluate alternative methods
-Review ongoing need regularly
-Use smallest-gauge catheter possible
-Use aseptic technique/sterile equipment
-Use barrier precautions for insertion
Literature review
Alternatives to an indwelling urethral catheter
-randomized comparative trial reported
that the use of external condom catheter drainage
for men compared with a short-term indwelling urethral catheter reduced acquisition of bacteriuria and adverse outcomes and was more acceptable to the patient.
- A randomized study reported that in-and-out catheterization was as effective as the use of an indwelling catheter for management of postoperative retention.
-Association for Professional in Infection Control and Epidemiology (2008). Guide to the
-Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs). Retrieved from
-Celis, R., Torres, A., Gatell, J., Almela, M., Rodriguez-Roisin, R., & Agusti-Vidal, A. (1988). Nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest, 93(2), 318-324.
-Checklist for Prevention of Central Line Assiciated Blood Stream Infections (2011). Centers for Disease Control. Retrieved from http://www.cdc.gov/HAI/pdfs/bsi/checklist-for-CLABSI.pdf
-CLABSI prevention success pressures hospitals to adopt similar programs. (2011). Hospital Infection Control & Prevention, 38(4), 37-41.
-Harnage, S. (2012). Seven years of zero central-line-associated bloodstream infections. British Journal Of Nursing, S6-s12.
Kollef, M. H. (2011). Recognition of Nosocomial Pneumonia in the Intensive Care Unit: Still a Confusing
Issue. Respiratory Care, 56(8), 1209-1212. doi:10.4187/respcare.01409
-Kusek, L. (2012). Preventing central line-associated bloodstream infections. Journal Of Nursing Care Quality, 27(4), 283-287.
-Lo, E., Nicolle, L., Classen, D., Arias, K., Podgorny, K., Anderson, D., & ... Yokoe, D.
(2008). Strategies to prevent catheter-associated urinary tract infections in acute care
hospitals. Infection Control & Hospital Epidemiology, 29S41-50.
-Meddings, J., Reichert, H., Rogers, M., Saint, S., Stephansky, J., & McMahon, L. (2012). Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Annals Of Internal Medicine, 157(5), 305-312. doi:10.7326/0003-4819-157-5-201209040-00003
-Meddings, J., Saint, S., & McMahon, L. r. (2010). Hospital-acquired catheter-associated
urinary tract infection: documentation and coding issues may reduce financial impact of
Medicare's new payment policy. Infection Control & Hospital Epidemiology, 31(6), 627-
-Myrianthefs, P., Kalafati, M., Samara, I., & Baltopoulos, G. (2004). Nosocomial pneumonia. Critical Care
Nursing Quarterly, 27(3), 241-257.
-O’Grady, N., Alexander, M., Burns, L., Dellinger, P., Garland, J., Heard, S., …HICPAC (2011). Guidelines for the Prevention of Intravascular Catheter-Related Infections. Retrieved from http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
-Picture retrieved from http://i645.photobucket.com/albums/uu174/happyhospitalist/HH%20original%20ecards/NursesprayerkeepFoleycatheteruntilendofshift_zps5b148c7f.png
-Picture retrieved from http://academic.pgcc.edu/~kroberts/Lecture/Chapter%2014/14-19_Nosocomial_L.jpg
-Picture retrieved from http://images.ddccdn.com/cg/images/en141690.jpg
-Picture retrieved from http://1.bp.blogspot.com/-F92FSGr_Ato/UR50UWlqikI/AAAAAAAAAY0/B-xX30AA3cw/s1600/Pneumonia+Nursing+Diagnosis+Interventions.jpg
-Picture retrieved from http://www.mountainside-medical.com/product_images/uploaded_images/urinary-drainage-bags.jpg
-Picture retrieved from http://sd.keepcalm-o-matic.co.uk/i/keep-calm-we-will-pass-nursing-school.png
-Picture retrieved from http://img.medicalexpo.com/images_me/photo-g/critical-care-artificial-ventilator-70428-150737.jpg
-Vital signs: central line--associated blood stream infections --- United States, 2001, 2008, and 2009. (2011). MMWR: Morbidity & Mortality Weekly Report, 60(8), 243-248.
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