” Task Force for Reducing Hospital Acquired Infections” Indicators and quality improvement Nordisk Hygienkonferens Gøteborg 10-12 september 2014 Bettina Lundgren, centerdirektør, dr. med. •Formand for Region Hovedstadens ”Task Force” for Halvering af hospitalserhvervede infektioner •[email protected] 11 hospitals 1.6 million inhabitants ”Task Force” for Reducing Hospital Acquired Infections In 2010 the Capital Region of Denmark decided to reduce hospital acquired infections (HAI) by 50%. ”Task Force for Reducing Hospital Acquired Infections” 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) ”Task Force” for Reducing Hospital Acquired Infections Surveillance in the Capital region and in Denmark Capital region - committee for infection control and ”Task Force” National and international organisations Hospitals Infection control comities Clinicians Departments of Clinical Microbiology ”Task Force” for Reducing Hospital Acquired Infections Organisation Committee for Infection Control and Hygiene, the Capital Region of Denmark Task Force for Reduction of Hospital acquired Infections Bacteremia VAP Antibiotic consumption & bacterial resistance MRSA UTIs SSIs CVCrelated infections Clostridium difficile ”Task Force” for Reducing Hospital Acquired Infections Mikrobiologiske databaser LPR Landspatientregistret: Indlæggelser og udskrivelser - MADS - ADBakt EPM Elektronisk Patientmedicinering: Medicinforbrug CIS DOMUS Critical Information System: Patienter på intensive afdelinger (VAP) Postoperative sårinfektioner (Ortopædkirurgi) Kliniske kvalitetsdatabaser - Karbase ”Task Force” for Reducing Hospital Acquired Infections • News letter • News • Data • Information • Intranet: • Data (monthly) • Background • What works ”Task Force” Halvering af infektioner Ventilator-associeret pneumoni (VAP) VAP pr. 1.000 respiratordage 1. kvartal 2010 - 1. kvartal 2014 Intensive afdelinger, Region Hovedstaden 20 18 16 14 12 10 8 6 4 Målsætning 2 0 2010 2011 2012 2013 RH Multidisciplinær RH Neurointensiv RH Hjerteintensiv RH3163 (N/A) Hvidovre Hospital (til 30/4-2012) Bispebjerg Hospital Bornholms Hospital (N/A) Nordsjællands Hospital Gentofte Hospital Glostrup Hospital Herlev Hospital Målsætning 2014 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. 1.000 respiratordage. Ny afdeling er Hjerteintensiv på Rigshospitalet, der har registreret VAP siden 1. januar 2014. ”Task Force” Halvering af infektioner Postoperative sårinfektioner, Ortopædkirurgi Kirurgisk behandlingskrævende infektion efter primær knæalloplastik, 2009 - 4. kvartal 2013 Ortopædkirurgiske afdelinger, Region Hovedstaden 5,0% Ca. 2000 pt/år får knæalloplastik 4,0% 3,2% 3,0% 2,3% 2,0% Målsætning 1,1% 1,0% 0,9% 1,0% 2012 2013 0,0% 2009 Kofidensinterval 2010 2011 Reopereret pga. infektiøs komplikation Målsætning Kommentarer: Der var i 4.kvartal 2013 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 2013 er 1,3 %. Infektionsraten har siden 2011 ligget omkring 1 %. Clostridium difficile og Clostridium difficile 027 pr. 10.000 beddays 2010 – 2013 Capital Region 35 30 25 20 15 10 5 0 2013 2012 2011 2010 Hvidovre 2013 2012 2011 2010 2013 2012 2011 2010 Herlev 2013 2012 Andelen af CD027 2011 Glostrup 2010 2013 Bornholm Frederiksberg Gentofte 2012 Bispebjerg 2011 2010 2013 2012 2011 2010 2013 2012 2011 2010 2013 2012 2011 2010 2013 2012 2011 2010 2013 2012 2011 2010 Amager NordRigshospitalet hospitalerne New cases of Clostridium difficile, Clostridium difficile 027 and Clostridium difficile-burden pr. 10.000 bed days Herlev Hospital 50 40 30 20 10 0 CD 027 pr. 10.000 sengedage Nye tilfælde af CDI pr. 10.000 sengedage Burden pr. 10.000 sengedage 0 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 Reducing Hospital Acquired Infections Vancomycinresistant Enterococcus faecium (VRE) at four different hospitals 2013-2014 45 Patients with VRE pr. month january 2013 – april 2014 40 35 30 25 20 15 10 5 Rigshospitalet Herlev Hvidovre Bispebjerg Hospital ”Task Force” for Reducing Hospital Acquired Infections 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 ”Task Force” for Reducing Hospital Acquired Infections A challenge to share experience! ”Task Force” for Reducing Hospital Acquired Infections 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 ”Task Force” for Reducing Hospital Acquired Infections Interventions and quality improvement • Task Force network • Best clinical practice • Data management • Local context and culture • Leadership • Sharing knowledge • Education programs ”Task Force” for Reducing Hospital Acquired Infections Acknowledgements •Task Force Steering committee: •Bettina Lundgren1, Christian Østergaard Andersen2, Jens Otto Jarløv3, Helle Krogh Johansen1, Jan Utzon4, Monika Madsen4, Jacob Anhøj1, Jenny Dahl Knudsen2, Rie Mikkelsen2, Christian von Plessen6, Annabel Krarup2, Bente Olesen4 • Bacteremia working group: •Christian Østergaard Andersen2, Jenny Dahl Knudsen2, Magnus Arpi4, Mette Pinholt4, Michael Tvede1, Claus Moser1, Ann Filippa Madsen4, Steen Rasmussen2 •Ventilator associated pneumonia (VAP) working group: •Jakob Steen Andersen1, Inger Gillesberg4, Morten Steensen1, Asger Petersen5, Dorte Buhl4, Joakim Bay Simonsen1 • Central Venous Catheter (CVC)-related infection working group: •Jens Otto Jarløv4, Mette Østergaard6, Torben Callesen4, Jakob Steen Andersen1, Leif Percival Andersen1, Lisbeth Kyndi Bergen1 • Surgical Site Infection (SSI) working group: •Annabel Krarup2, Ole Michael Nielsen1, Nini Møller6, Anne-Marie Blok Hellesøe1, Anne-Marie Thye6 •MRSA working group: •Henrik Westh2, Ina Sleimann Petersen4, Heidi Meiniche2, Mette Bartels2, Kirsten Kristoffersen2, Helle Neustrup1, Steen Rasmussen2 • Clostridium difficile working group: •Bente Olsen4, Michael Tvede1, Jette Bangsborg2, Søren Thorsen6, Anne Lester2, Marie Stangerup5, Jette Nygaard Jensen4 • Antibiotic consumption & bacterial resistance working group: •Jenny Dahl Knudsen2, Magnus Arpi4, Stig Ejdrup Andersen5, Helle Krogh Johansen1, Barbara Holzknecht4, Dennis Schrøder Hansen4, Jannik Helweg-Larsen1, Jette Houlind8, Jonas Boel4, Thor Schmidt9, Jette Nygaard Jensen4 •Urinary Tract Infection (UTI) working group: •Niels Frimodt-Møller1, Jørgen Balslev Jørgensen7, Dina Cortes2, Leif Percival Andersen1, Helle Neustrup1, Steen Rasmussen2 •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
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