Patient Safety in the ICUs Speaker 2010-2012 http://www.eu-implement.info
1. Overview Project mangement: • Barcelona, Spain • Brussels, Belgium • Freiburg, Germany • Msida, Malta • Nijmegen, Netherlands • Rome, Italy Objective: „Providing policymakers, managers and healthcare workers with the knowledge on the implementation of improvement measures (bundles) in patient care for the prevention and management of healthcare- associated infections (HAIs).“
2. Context/Public health problem Healthcare-associated infections (HAIs) are considered to be the greatest risk for hospitalised patients, leading to a substantial increase in morbidity, mortality and costs in EU member states. • Approx. 5-10% of hospitalised patients acquire HAIs while receiving treatment for medical or surgical conditions. There are approximately 4.1 million HAIs and 30-50,000 attributable • deaths each year.
3. Key activities (1) Prevention of Catheter-Related Blood Stream Infections • Survey of policies and practices for the prevention and management of catheter-related bloodstream infections (CRBSIs) in European hospitals • Identification of implementation tools and momentous gaps in the adoption of the central venous line bundle (CVL- Bundle) for the prevention and control of CRBSIs
3. Key activities (2) Prevention of Ventilator-Associated Pneumonia (VAP) • Survey of policies and practices for the prevention and management of ventilator-associated pneumonia (VAP) in European intensive care units (ICUs) • Identification of the most powerful implementation tools and the momentous gaps in the adoption of the ventilator bundle (V-Bundle) for the prevention and control of VAP
3. Key activities (3) Implementation of strategies to increase patient safety in the ICU • Bringing together pilot experiences from EU hospitals • Learning to improve complex systems of care • Providing an overview of evidenced-based organisational strategies
3. Key activities (5) Optimal Experimental Design for Future Studies • Providing a base for future testing of the clinical effectiveness of implementation processes for bundled interventions in a diverse sample of European hospitals • Identification of the optimal study design balanced between statistical requirements and feasibility
4. Results (1) Online questionnaire survey from hospitals in 29 European countries
4. Results (2) A total of 1,730 replies from 77 countries ; → 1,281 replies from 16 countries used to compute weighted European estimates: • Care for intubated patients, combined with measurement of compliance to guideline for hand hygiene: 57% of the respondents (95% CI: 54–60) • Systematic daily interruption of sedation and weaning protocol: Only 28% (95% CI: 24–33) • Oral care protocol (e.g. with chlorhexidine): Only 27% (95%: 23–30) • Provision of estimated outcome data (VAP rate) in the ICU: Only 20% (95% CI: 17–22) • However, 93% (95% CI: 91–94) agreed that “Monitoring of VAP-related measures will stimulate quality improvement and patient safety“.
4. Results (3) The availability of VAP surveillance systems + written standards for management of mechanically ventilated patients in the ICU are positively associated with → compliance with VAP prevention measures and, therefore, should be fostered on a policy level. VAP prevention measures Average compliance with Written clinical guidelines for VAP prevention
Conference dissemination activities • Forum on Quality and Safety in Healthcare, Nice, France, April 20 ‐ 23, 2010. International conference with approximately 2.000 participants ‐ Active workshop attendance • ECCMID Vienna, Austria April 10 ‐ 12, 2010. International conference with approximately 8.000 participants ‐ Poster presentation at network corner • ICAAC, Boston MA, September 11 ‐ 15, 2010. International conference with approximately 10.000 participants ‐ Presentation at network corner • Forum on Quality and Safety in Healthcare, Amsterdam, NL, April 5 ‐ 8, 2010. International conference with approximately 2.000 participants ‐ Poster presentation at network corner • ECCMID Milan, Italy, May 7 ‐ 10, 2011 International conference with approximately 8.000 participants ‐ Poster presentation at network corner • ECCMID London, UK, April 1 ‐ 3, 2012 International conference with approximately 8.000 participants ‐ Poster presentation at network corner ‐ European epidemiology of MRSA bacteraemia: effective prevention requires more than just good hospital policies, M.A Borg, E. Scicluna, U. Frank on behalf of the Implement Project Group ‐ Evidence ‐ based recommendations to increase the appropriate usage of antibiotics in ICU patients: a 5 ‐ day bundle. De Angelis*, P. De Santis, F. Di Muzio, C. Palazzolo, A. Brink ‐ Huis, M. Hulscher, U. Frank, M. Antonelli, E. Tacconelli • ECCMID Berlin, Germany, April 21013 International conference with approximately 8.000 participants ‐ Poster presentation at network corner
5. Sustainability and Transferability There is a wide range of Generalizabilty potential study designs, however, to yield internally valid results, randomization is needed.
6. Contact Uwe Frank, MD Division of Infection Control and Hospital Epidemiology Department of Infectious Diseases Heidelberg University Hospital Im Neuenheimer Feld 324 69120 Heidelberg, Germany Phone: (+49) 06221 56 8208 Mobile: (+49) 0171 280 7798 uwe.frank@med.uni-heidelberg.de
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