Infection Rates Definitions and Infection Prevention Practices

•   Infection Rates •   Definitions and best practices •   Infection rate data •   How you can prevent infections

Surgical Site Infection

A surgery site infection (SSI) involves any part of the body that is opened or manipulated during the operative procedure.  A SSI occurs within 30 days after the operative procedure if no implant is left in place or within one year if implant is in place and the infection appears to be related to the operative procedure.

Class I (Clean) Surgical Site Infections

An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital or uninfected urinary tract is not entered.

Class II (Clean-contaminated) Surgical Site Infections

An operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.

Surgical Infection Prevention Practices

CHS follows best practices to reduce SSIs and  monitors and follows all guidelines for:

	•	Antibiotic timing
	•	Antibiotic selection
	•	Antibiotic discontinuation
	•	Appropriate preoperative hair removal
	•	Glucose levels in the cardiac surgical patients
	•	Perioperative normothermia
	•	Appropriate venous thromboembolism prophylaxis

Ventilator Associated Pneumonia

Ventilator-associated pneumonia (VAP) is a healthcare associated lung infection that occurs in patients receiving mechanical ventilation through a tube for at least 48 hours and for whom the infection was not the reason for ventilation.

VAP Prevention Practices

Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices. CHS follows HICPAC (Healthcare Infection Control Practices Advisory Committee) and CDC guidelines and the IHI recommended bundle for the prevention of HAI pneumonia.

The following series of interventions to ventilator care  will achieve significantly better outcomes. Key components of the Ventilator bundle include:

	•	Elevation of the head of the bed
	•	Daily "sedation vacations" and assessment of readiness to extubate (remove the endotracheal tube to test if the patient can breathe without  the assistance of the ventilator)
	•	Peptic ulcer disease prophylaxis
	•	Deep venous thrombosis prophylaxis
	•	Daily oral care with Chlorhexidine

 The Surgical Intensive Care Unit is divided into two units for this measurement:

SICU Neurosurgical

Not every hospital has this specialized group of patients, who pose a challenge in following the bundle for the prevention of VAP. These patients often are not able to have their head elevated or undergo the intense stimulation required for a sedation vacation. Collecting separate data for this population enables us to address this group’s specific needs, allowing us to take the neurosurgical VAP rate from 7.2 in 2009 to 0 in the first quarter of 2010.

SICU Non-Neurosurgical

The healthcare team is able to consistently follow the bundle with this patient population. VAP Team conducts timely review of infections, products, and process changes occurs at CHS by utilizing this multidisciplinary team.

Central Line Associated Infection

Central Line Associated Infection (CLABSI) is a bloodstream infection associated with use of a catheter (central line)that terminates at or close to the heart or in one of the great vessels.

CLABSI Prevention Practices

The following suite of interventions to central line care will achieve significantly improved outcomes. Key components of the central line bundle include:

	•	Central line insertion process: a detailed checklist
	•	Promotion of hand hygiene
	•	Maximal barrier precautions used during insertion<
	•	Chlorohexidine skin antisepsis prior to insertion
	•	Optimal catheter site selection
	•	Prompt removal of unnecessary lines

CLABSI Team

The multidisciplinary CLABSI team focuses on timely review of infections, products, and process changes for CLABSI.

Catheter Associated Urinary Tract Infection

Catheter Associated Urinary Tract Infection (CAUTI) is a urinary tract infection associated with the use of an indwelling urethral (the transport tube leading from the bladder to discharge urine outside the body) catheter.

CAUTI Prevention Practice

The following suite of interventions is a systemwide program to reduce Foley catheter infections and will achieve significantly improved outcomes. Key components of the Foley catheter bundle include:

	•	Aseptic (free from germs) insertion and proper maintenance
	•	Promotion of hand hygiene
	•	Prompt removal of unnecessary catheters
	•	Bladder ultrasound to avoid catheter reinsertion
	•	Closed drainage system
	•	Foley below the level of the bladder
	•	Foley securement device
	•	Provide alternatives to Foley catheter insertion: condom catheter, diaper, etc . . .

Methicillin-Resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of staph bacteria that is resistant to the antibiotics commonly used to treat ordinary staph infections.

There are two types of MRSA infections that can occur:

Healthcare-associated MRSA (HA-MRSA) can occur in people who have been in the hospital or other healthcare settings. This type is typically associated with invasive procedures or devices.

Community-associated MRSA (CA-MRSA) frequently begins with a painful skin boil and can be spread by skin contact.

MRSA Prevention Practice

CHS follows recommended best practice to reduce MRSA including:

	•	Use guidelines and recommendations from the experts for the reduction of multi-drug resistant organisms in a healthcare setting
	•	Active surveillance cultures for MRSA within 24 hours of admission on high risk patients, using state-of-the-art lab instrument for rapid detection of MRSA to identify patients within hours instead of days.
	•	Provide alcohol-rub towelettes at the patient’s bedside
	•	Isolation guideline policy
	•	The Infection Prevention and Control Dept. follows all new and previously positive patients with multi-drug resistant organisms
	•	Stringent environmental cleaning processes
	•	Respiratory etiquette and hand hygiene stations throughout facility
	•	Observational hand hygiene studies with feedback to staff and physicians
	•	Infection control liaison assigned to each unit
	•	Ensure surgical patients receive appropriate pre-op antibiotics
	•	Education for employees, physicians, visitors, patients and the community