Global Patient Safety Challenge 2005-2006 · World Alliance for Patient Safety Global Patient...
Transcript of Global Patient Safety Challenge 2005-2006 · World Alliance for Patient Safety Global Patient...
Jan10/2005-DP - DIRECTION/PRESENTATIONS/ICSTRUCTURE/PatientSafetyChallengeWHONairobiDurban
Professor Didier Pittet, MD, MS,
Infection Control ProgramUniversity of Geneva Hospitals, Switzerland
and
Division of Investigative ScienceImperial College of Science, Technology, and
Medicine, London, UK
WHO World Alliance for Patient SafetyGlobal Patient Safety Challenge
2005-2006Nairobi – Durban / January 2005
In UK, nosocomial infections may beresponsible for > 5’000 deaths/year
BMJ 2.12.2000
Nosocomial infections
Every year in the US,preventable hospital-acquired diseases,
including nosocomial infections,are responsible for 44’000-98’000 deaths
Kohn Institute of Medicine 1999US$17 to US$29 billion / year
at least £ 1 billion / year
02
46
810
1214
1618
1841
1842
1843
1844
1845
1846
Maternal Mortality
FirstSecond
Semmelweis IP, 1861
(%)
Maternal mortality rates, First and Second Obstetric Clinics, GENERAL HOSPITAL OF VIENNA, 1841-1846
Intervention
Students and doctors were required to:
clean their hands with a chlorinated lime solution when entering the labor room
in particular when moving from the autopsyto the labor room
May 1847
Maternal mortality rates, First and Second Obstetrics Clinics,
GENERAL HOSPITAL OF VIENNA, 1841-18500
24
68
1012
1416
18
1841 1842 1843 1844 1845 1846 1847 1848 1849 1850
Mat
erna
l Mor
talit
y
FirstSecond
Intervention
Semmelweis IP, 1861
May 15, 1847
Infection Control and Quality Healthcare in the New Millenium
What did we learn from the early days ?
RecognizeExplain
Act
SENIC study
Study on the Efficacy of Nosocomial Infection Control
0%
10%
20%
30%Relative change in NI in a 5 year period (1970-1975)
-31% -35%-35%-27%
-32%-40%
-30%
-20%
-10%
With infection control
14%9%
19%26%
18%
Without infection control
LRTI SSI UTI BSI Total
Haley RW et al. Am J Epidemiol 1985;121(2):182-205
SENICStudy on the Efficacy of Nosocomial Infection Control
1 infection control nurse per 200 to 250 beds
1 hospital epidemiologist per hospital (1000 beds)
Organized surveillance for nosocomial infections
Feedback of nosocomial infection ratesHaley RW et al. Am J Epidemiol 1985;121(2):182-205
per 110 beds
1st principle of infection prevention35-50% of all nosocomial infections are associatedwith only 5 patient care practices:
Use and care of urinary cathetersUse and care of vascular access linesTherapy and support of pulmonary functionsExperience with surgical proceduresHand hygiene and standard precautions
1st principle of infection prevention35-50% of all nosocomial infections are associatedwith only 5 patient care practices:
Use and care of urinary cathetersUse and care of vascular access linesTherapy and support of pulmonary functionsExperience with surgical proceduresHand hygiene and standard precautions
1. Recognize2. Explain3. Act
0
2
4
6
8
10
12 Primary bacteremia / 1000 CVC-days
1995 1996 1997 1998 1999 2000 2001 2002
Eggimann et al.Lancet 2000
Coopersmith et al.CCM 2002
Warren et al.CCM 2003
SherertzAnn Intern Med 2000
Education-based prevention of vascularcatheter-associated bloodstream infection
Eggimann et al.ICAAC 2001ICAAC 2004
112 MICUs (NNIS)
146 SICUs (NNIS)
NNIS Am J Infect Control 1999
Efficacy of prevention
Level 1basic
measures
30 %
Basic hygieneSurveillanceFeedback
Level 2optimalization
EducationTechnical aspectsGlobal approach
60-80 %
expectedessential
Level 3new
technologies
>90 %
??
Catheterscoated withantibiotics /antiseptics
Stepwise prevention of catheter-related infection
1st principle of infection prevention35-50% of all nosocomial infections are associatedwith only 5 patient care practices:
Use and care of urinary cathetersUse and care of vascular access linesTherapy and support of pulmonary functionsExperience with surgical proceduresHand hygiene and standard precautions
Opportunities for hand hygiene per patient-hour of care 8 12 16 20
35
45
55
65
ICU
surgery
medicine
ob / gyn
pediatrics
Com
plia
nce
with
hand
hyg
iene
(
, %)
Relation between opportunities for hand hygienefor nurses and compliance across hospital wards
adapted from Pittet D et al. Annals Intern Med 1999; 130:126
On average,22 opp / hourfor an ICU nurse
1. Recognize2. Explain
Observed reasons for not washing handsTime and system constraints
• High demand for hand hygiene isassociated with low compliance
• Full compliance with conventional guidelines is unrealistic
Voss and Widmer - Inf Control Hosp Epidemiol 1997; 18:205Pittet et al, Annals Intern Med 1999; 130:126
Time constraint = major obstacle for hand hygiene
handwashinghand antisepsis
1 to 1.5 min
alcohol-basedhand rub
15 to 20 sec
Handwashing …an action of the past(except when hands are visibly soiled)
Alcohol-based hand rub is standard of care
1. Recognized2. Explained
3. Act
Alcohol-basedhand rub atthe point ofcare
Before and after any patient contactBefore and after glove useIn between different body site care
Ignaz Philipp Semmelweis before and after he insisted that students and doctors clean their hands with a chlorine solution between each patient
Doctor, in this hospital,it’s become impossibleto cause infectionsany more !
The University of Geneva Hospitals
against DIRTY STAPH :war has been declared
www.hopisafe.ch
Pittet D et al, Lancet 2000; 356: 1307-1312
Hospital-wide nosocomial infections; trends 1994-1998
Key parameters for success
System changeAdministrative supportEducation of healthcare workersMonitoring and feedback ofperformanceChange in behaviorAssociated with complianceimprovement and reduction in cross-transmission and infection rates
Infection control in developingcountries: main issues
Unfavorable social background
Facilities badly structured and equipped
Technological gap
Lack of adequate conditions in hospitals
Inadequately/insufficiently equippedInadequate hygiene conditionsLack of microbiological dataUnderstaffing
• Pessoa-Silva et al J Pediatrics 2002;141:381-7.
Overcrowding• Merchant et al J Hosp Infect 1999;38:143-148.
– Bed occupancy exceeding capacity: 140%!
Low staff preparedness• Issack MI J Hosp Infect 1999;42:339-344.
– Unecessary measures / lack of adequate measures
ConsequencesUnsafe invasive procedures
• Simonsen et al. Bull WHO 1999;77:789-800.50% injections = unsafe in 14 out of 19 countries
sepsis, hepatitis B and C, HIV, Ebola, Lassa and malaria
Nosocomial outbreaks of introduced communitypathogens
• Paton et al. Infect Control Hosp Epidemiol 1991;12:710-7Shigella spp. / Salmonella spp.
Spread of multiresistant microorganisms• Hart & Kariuki BMJ 1998;317:647-50.
Higher healthcare-associated infection rates
ConsequencesHigher device-associated nosocomial rates
4.94.94.9Med/SurgICU
NNIS, USA
18.546.330.3Med/SurgICU
Rosenthal, 2004, Argentina
22.651.044.6Med/SurgICU
Rosenthal, 2003, Argentina
4.32.25.9PICUNNIS, USA
1.818.710.2PICUAbramczyk, 2003, Brazil
CR-UTI*VAP*CR-BSI*SettingAuthor, year, country
* Device-related rate= Number of infections/1000 device-days
ConsequencesInadequate use of technology
Review of cases of nosocomial Lassa fever in Nigeria: thehigh price of poor medical practiceFisher-Hoch et al. BMJ 1995;311:857-859.– 34 cases (9 HCWs)– 55% attack rate– 65% fatality rate– Outbreak linked to:
• Hospitals inadequately equipped and staffed• Poor medical practice• Sharing of syringes• Staff contamination during emergency surgery
Perspectives Improvement in hygiene conditionsStaff training
• Brazil: Calcante et al Infect Control Hosp Epidemiol 1991;12649-53.HAI rates
Savings: ~ US$ 2 million• Thailand: Thamlikitkul et al. J Clin Epidemiol 1998;51:773-8.
20% atb use
Surveillance strategy– Selective surveillance
• Brazil: Lima et al Infect Control Hosp Epidemiol 1993;14:197-202.
– Feasible epidemiologic markers• Argentina: Kurlat et cols. J Hosp Infect 1998;40:149-154.
Impact of hand hygiene education in thecommunity in a developing country
Luby et al. JAMA 2004; 291: 2547-2554
Cluster-randomized study (villages)Rural community in PakistanIntervention: education with focus on hand hygiene
and distribution of soapResults– diarrhoea– skin infections– respiratory infections– mortality among children
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
Healthcare-associated infections– affect millions of patients worldwide every year– more serious illness– prolong hospital stay– long-term disability– high costs on humans and their families– excess deaths– massive additional financial burden
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
Affects a large number of individualsworldwideMultifaceted causation related to– systems and processes of care provision– human behavior– political and economical constraints on
systems/countries
Patient safety gap (some healthcare institutions/systems control the risk to patients much better than others)
Data to assess the size and nature of theproblem and to create the basis for monitoring the effectiveness of actions
Health-care associated infection is a major patient safety problem
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
Clean Care is Safer Care
Major action areas– Improve hand hygiene– Injection safety–Blood safety–Safety associated with healthcare-
related procedures–Environment-related issues
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
Clean Care is Safer Care
Driven by WHOAssociation with key partnersCountries invited to adopt the challenge for their own healthcare systemWork closely with one healthcare area in each of the 6 WHO regions
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
Clean Care is Safer Care
Countries (almost 200 members) will be invited to adoptthe challenge for their own healthcare systems withthe following principles:
Assess the scale and nature of HAIAdopt an internationally recognized approach to surveillance so that a baseline can be establishedand changes monitoredConduct root causes analyses with particularemphasis on «system thinking»Develop solutions to improve safety and reduce risk
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
Clean Care is Safer Care
Countries (almost 200 members) will be invited to adoptthe challenge for their own healthcare systems withthe following principles (continued):
Rely on evidence-based best practiceFully engage patients and service users as well as healthcare professionnals in improvement and action plansEnsure the sustainability of all actions beyond theinitial 2-year period of the Challenge
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
Clean Care is Safer Care
Countries (almost 200 members) will be invited to adoptthe challenge for their own healthcare systems withthe following principles:
Assess the scale and nature of HAIAdopt an internationnally recognized approach to surveillance so that a baseline could be establishedand change monitoredConduct root causes analyses with particularemphasis on « system thinking »Develop solutions to improve safety and reduce risk
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
Clean Care is Safer Care
To develop solutions to improve safety andreduce risk by focusing on 5 action areas:
Clean handsClean practicesClean productsClean environmentClean equipment
Clean Care is Safer Care
WHO guidelinesfor hand hygiene
WHO strategyfor hand hygiene
promotion
WHO strategyfor promotion ofclean practicesclean products
clean environmentclean equipment
Before / Afterevaluation
in 6 WHO districts
Gather togetherWHO materialfor infection prevention
–injection safety–blood safety–procedure safety–environment
World Alliance for Patient SafetyGlobal Patient Safety Challenge 2005-2006
time
Implementationof whole / part
of WHO strategiesfor prevention of
healthcareassociated infections
by members
From second partof 2005