Reduce HAI & BSI

 QIA Guidelines

The Network will:

o Assist facilities to implement and monitor all of the CDC recommended interventions for dialysis BSI prevention
o Educate target facilities on the CDC Core Interventions, and assist the facilities in implementing the CDC Core Interventions,
o Assist Facilities in monitoring their own progress toward implementing the CDC Core Interventions and reduction of BSIs, and
o Monitor the progress of QIA facilities and assist the facilities that are unable to progress to goal.
o Involve Patient SMEs and/or family members or care partners at the facility level in discussion about infection control practices and ways to feel more comfortable bring issues to the attention of staff members.

Facility Selection/Inclusion Criteria:  at least 50% of facilities in the Network’s service area including those facilities reporting the highest BSI rates.

Mandated Activities

ESRD National Coordinating Center HAI Learning and Action Network (ESRD HAI LAN):  Network and targeted facility staff are required to participate in the bi-monthly ESRD HAI LAN (1 hour webinar with nursing CE).  This LAN has two primary purposes. The first is to improve information communication across care settings, with emphasis on communication between hospitals and dialysis centers caring for the same ESRD patients. The second is to increase awareness of and implementation of CDC Core interventions.

Network Guidance:
Provide the facilities in the BSI QIA with guidance to implement all CDC recommended interventions for dialysis BSI prevention (Surveillance and feedback using NHSN, hand hygiene observations, catheter/vascular access care observations, staff education and competency, patient engagement/education, catheter reduction, chlorhexidine for skin asepsis, catheter hub disinfection, and antimicrobial ointment) that the facility has not adopted or is having difficulty successfully implementing.

Incorporate action steps developed from each ESRD NCC HAI LAN to assist facilities in implementing the COR interventions.

Encourage the dialysis facilities to discuss the use of the CDC Core Interventions at QAPI meetings, in addition to infection rates, with the Medical Director for the facility.

Assist facilities to complete a root cause analysis if there was successful implementation of all the CDC Core Interventions and the BSI rate did not decrease by at least 10% during the QIA.

Encourage facilities to participate in CDC HAI training activities by encouraging all clinical staff to complete the CDC Infection Prevention in Dialysis Settings Continuing Education course as well as view the CDC video “Preventing Bloodstream Infections in Outpatient Hemodialysis Patients: Best Practices for Dialysis Staff”.

Reduce Long Term Catheter (LTC) Use:  Use NCC provided data to identify facilities with a LTC (catheter in use > 90 days) in use rate above 15% (from the 50% of facilities in the Network’s service area reporting the highest BSI rates).

Goals:
LTC Goal: Decrease rate by at least 2 percentage points by evaluation based on June 2017 baseline data.
BSI Goal:  Demonstrate a 20% or greater relative reduction in the semi-annual pooled mean in the cohort with the highest 20% of BSIs in the Network service area at re-measurement compared to 2017.

Graduation Requirements: A facility may be removed and replaced for 2019 in the QIA if it is no longer in the cohort of facilities with the highest 20% of BSIs in the Network service area or maintains a BSI rate of zero for at least six (6) months of the QIA.

CMS Recommended Learning Activity:
Prevention of intravascular infections, blood-borne pathogen transmission (e.g., hepatitis B), and influenza and pneumococcal disease are priorities identified in the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination

Tools and Resources