Patient Safety in the ICUs Speaker 2010-2012 - - PowerPoint PPT Presentation

Speaker

Patient Safety in the ICUs

2010-2012 http://www.eu-implement.info

• 1. Overview

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).“

Project mangement:

• Barcelona, Spain
• Brussels, Belgium
• Freiburg, Germany
• Msida, Malta
• Nijmegen, Netherlands
• Rome, Italy

• 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
• f 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

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 (2)

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.

• 4. Results (3)

Average compliance with VAP prevention measures Written clinical guidelines for VAP prevention

• 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

Conference dissemination activities

• 5. Sustainability and Transferability

Generalizabilty There is a wide range of 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