” 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
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februar
marts
april
jan
feb
marts
april
maj
juni
juli
august
september
oktober
november
december
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februar
marts
april
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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