You can make a
difference:
Leading the change
by using the right
tools for the right
job!
Mags Moran
Community Infection Prevention &
Control Nurse Manager
CHO Area1 Donegal HSE Services
[email protected]
• How to Jump Start Infection
Prevention Saint et al, 2011
in your place of work!
Which hill will we climb today?
You mean I have to leave my cosy toasty nest?
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“ And let it be noted that there is no more
delicate matter to take in hand, nor more
dangerous to conduct, nor more doubtful in
its success, that to set up as a leader in the
introduction of changes. For he who
innovates will have for his enemies all those
who are well off under the existing order of
things, and only lukewarm supporters in
those who might be better off under the
new”.
Niccolo Machiavelli, The Prince (1513), as cited by Saint et al, 2011
What I hope we will cover
• Practice Development
• Quality Improvement
• Evidence based Practice
• Healthcare Innovation
& what they all have to do with IPC?
And finally,
Making a Difference!
Practice Development
• “Is a continuous process of developing personcentred cultures”. (Manley et al, 2008, pg9)
• Is an “approach that synthesizes activities &
theory of quality improvement, evidence- base
and innovations in practice, with real- practice
context, and with central focus on the
improvement of care & services for patients &
clients”. (Page & Hamer, 2002, pg 6)
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Quality Improvement in
Healthcare
‘The 6 Dimensions’
Institute of Medicine
(2001)
1. Effective
World Health Organisation
(2010)
1. Effective
2. Efficient
2. Efficient
3. Patient- centred
3. Patient- centred
4. Equitable
4. Equitable
5. Safe
5. Safe
6. Timely
6. Accessibility
Quality Improvement in
healthcare is the….
• “combined & unceasing efforts of everyonehealthcare professionals, patients and their
families, researchers, payers, planners and
educators- to make the changes that will lead to
better patient outcomes (health), better system
performance (care) and better professional
development”. (Batalden & Davidoff, 2007, pg2)
The Triad of Evidence based Practice
Clinical experience & judgement
Evidence- based Practice
“the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions”. Titler in Hughes (2008) drawing on the works of others…….
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Healthcare Innovation
• Innovation in healthcare is all about exploring
new approaches to the delivery of healthcare. It
challenges current practices & it is where you
will find the leaders within healthcare
• They are the one’s who have the vision, the
confidence and the tenacity to bring people with
them in implementing change. (Hughes, 2008, IOM)
• It would seem a natural assumption to make that all practice within healthcare must surely be based on the best evidence available at the time, but that is not always the case. (Institute of Medicine, 2001, Berwick, 2003, Grol & Grimshaw, 2003, Godin et al, 2008, Houser & Oman,
2011,Grimshaw et al, 2012, to name but a few).
So, what are the
Risks if we do not
change practice?
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The Risks‐ What we know….
• Patients with indwelling urinary catheters are at greater risk for developing UTIs with risk of bacteriuria increasing with each day of use:
• Per day: ~5 percent
• 1 week: ~25 percent
• 1 month: ~100 percent
We also know that‐
• The leading risk factors of CAUTI include prolonged catheterization, female gender, and catheter insertion outside of the operating room.
Surveillance Data
What do we know in Ireland in relation to UTIs/ CAUTIs?
The Evidence….
Acute Hospital Point Prevalence Study, May 2012
The top 4 HAIs identified by type=
1. Surgical site infection 2. Pneumonia – 20% associated with intubation
3. Urinary tract infection
– 41% associated with catheter
4. Bloodstream infection
– 42% associated with an IVC (HPSC, 2012)
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LTCF Point Prevalence Study, HALT
May 2013 & May 2016
The top 3 HCAIs identified by type=
1. Respiratory Tract Infections
2. Urinary Tract Infections
3. Skin Infections • 6% of those with a HCAI had a urinary catheter in situ. (HPSC, 2013)
What does the international evidence tell us about catheters?
1. Avoid unnecessary urinary catheters: STOP!
2. Insert urinary catheters using aseptic technique.
3. Maintain urinary catheters based on recommended guidelines‐Epic3 includes using QI systems 4. Review urinary catheter necessity daily and remove promptly.
IHI, (2011). ’How‐ to Guide: Prevent Catheter associated Urinary Tract Infections Is it SUTI or ABUTI?? Evidence will help us determine….
Device‐associated Module”, American Journal of Infection Control 39: (2011): 349‐67
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Peripheral Intravascular Devices:
The Risks, What do we Know?
• They are relied upon in acute care & non- acute care
• PIVC failure occurs in up to 69% of cases prior to
therapy completion
(Forni et al, 2012 and Maylon et al, 2014)
• PIVC failure was significantly associated with the
increasing episode rate of PIVC access per day (Keogh et al,
2016)
• Re- siting PIVCs is now based on clinical indication & no
longer done routinely (i.e. every 72hrs) (Epic3, 2014 and HSE/HPSC
&RCPI, 2014)
• Complications: Phlebitis, local infection, bloodstream
infection, infiltration, extravasation, occlusion &
inadvertent removal
What are we doing with this Evidence?
• The Science of Improvement……..
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Translation Science
• Implementation Science • Research Utilization • Communication
• Diffusion of Innovation
• Continuing Education • Continuing Professional Development • Knowledge Management
Remember: What we are trying to do is implement….
Evidence‐ based Practice in our everyday work!!
• What tools are out there for
us right now?
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Care Bundles…….
“ A small set of evidence‐ based interventions for a defined patient segment/ population and care setting that, when implemented together, will result in significantly better outcomes than when implemented individually”.
(IHI, 2012).
In terms of CAUTI, what evidenced‐ based quality improvement tools are at our disposal???
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Figure 1
Evaluation of an Evidence‐Based, Nurse‐Driven Checklist to Prevent Hospital‐Acquired Catheter‐
Associated Urinary Tract Infections in Intensive Care Units.
Fuchs, Mary; Ann DNP, RN; Sexton, Daniel; MD, FACP; Thornlow, Deirdre; PhD, RN; Champagne, Mary; PhD, RN
Journal of Nursing Care Quality. 26(2):101‐109, April/June 2011.
DOI: 10.1097/NCQ.0b013e3181fb7847
Figure 1 . Indications for Initiation and Continuance of Urinary Catheterization. Reprinted with permission. Copyright 2010, Duke Infection Control Network.
© 2011 Lippincott Williams & Wilkins, Inc. Published by Lippincott Williams & Wilkins, Inc.
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NICE, (2012). Long‐term urinary catheters:
prevention and control of healthcare associated infections in primary and community care
NICEPathways
Comprehensive Unit- based Safety
Program: CUSP
At Unit level you want
to:
1) Promote the appropriate use
of indwelling catheters
2) Improve the culture of safety,
teamwork & communication
3) Improve proper placement
technique & care of the
catheter.
In terms of PIVC infections, what evidenced‐ based quality improvement tools are at our disposal???
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• Are there Other Tools??
Sepsis Care Bundle:
6 Steps to Save a Life
Palliative Care, Care Bundle
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Pressure Area Care Bundle:
SSKIN
Antibiotic Care Bundle:
Acute Care
Environmental Hygiene Care Bundle
The organisation has
1. Written policies & procedures in relation to cleaning & disinfection
2. The evidence base to justify the selection of cleaning & disinfectant products
3. The evidence base to justify the selection of method of product application
(e.g. equipment etc)
4. Education programmes for staff on cleaning & disinfection
5. Monitors cleaning & disinfection practices
6. Provides timely feedback.
Havill, 2013
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• And coming to a unit near
you soon, is the ‘How- toGuide’ for Hand Hygiene
Training!
• So, Where do you start?
http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
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The 4 Es Model
1. Engage: How will this make the world a better place?
2. Educate: How will we accomplish this?
3. Execute: What do we need to do? 4. Evaluate: How will we know we made a difference?
Very similar to the PDSA cycle!
The John Hopkins Model for
Translating Evidence into Practice
Pronovost et al, 2008
Sometimes…..
• I feel that in many instances we fail
to recognise and learn from our
successes……
Me!
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For me‐ this is what IP&C is good at…… And I would include a
5th piece, that of-
Open Disclosure!
PD
QI
EBP
HI
We DO make a difference…..
“The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been. (Don Berwick, 2004)
• And so, to conclude…….
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I hope after this course‐ that you all feel that you can soar a little higher & be the pebble that starts the ripple effect of safer, better care in your place of work!
Always remember that…….
“Practice is science touched
with emotion”.
Stephen Paget in ‘Confessio Medici’, (1909, page 6).
“We are what we repeatedly do.
Excellence, therefore, is not
An act but a habit”.
Quote attributed to Aristotle, 384- 322 BC
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This is you!
•Thank You for
your participation
& attention!
•Questions/
Comments/
Feedback…….
References supplied on separate A4 sheet!
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