Infection Control Today

FEB 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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17 January/February 2019 ICT STEP 1: Introduction, problem and proposed solution: __________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Example 1: Introduction: Over the course of the past fve years, the hospital patient census has increased by 20 percent with the opening of two Intensive Care Units. Due to recently enforced state required reporting of infection rates resulting in a 40 percent increase in clerical time for the two full time IPs, it has not been possible to dedicate time to the ICU and device associated infection prevention. If a full-time analyst/clerical position were added, this would free up clinical IP time to for focus in surgical services. Currently our orthopedic SSI SIR is 2.0 – far above the national average. Problem: Current IP Program staffing level (FTEs) are insuffcient to optimize prevention of HAI for inpatients and outpatients as evidenced by CLABSI and CAUTI SIR 2.0 for 12 months. Proposed solution: Increase IP program staffng by 1.0 FTE Clerical position, for automated infection surveillance, public reporting, to free up clinical IP experts to coordinate enhanced CLABSI, CAUTI prevention plan. Example 2: Introduction: Over the course of the past 5 years, the hospital patient census has increased by 20 percent with the addition of colorectal surgery. Despite a four-point colorectal SSI prevention bundle, the SIR has remained at 2.0 for 12 months. Currently there is a wide variation among colorectal surgeons with regard to intraoperative surgical irrigation, with some using antibiotic irrigation and some using saline alone. Problem: Current SSI rate for colon procedures >1.0 SIR for 12 months despite 4 point SSI prevention bundle (preop CHG bathing, antibiotics, skin prep, antimicrobial sutures) Proposed solution: Implementation of 0.05% sterile chlorhexidine surgical irrigation solution prior to closing for each case. STEP 2: Estimated cost of proposed solution: __________________ _________________________________________________________ Example 1: 1.0 clerical staff FTE for IP department = $40K/year Example 2: $50/Liter 0.05% chlorhexidine sterile irrigation per case x 100 cases = $5,000 STEP 3: Estimated cost of current relevant HAI: _________________ _________________________________________________________ _________________________________________________________ Example 1: CLABSI incidence past 12 months = 10 x $45814 per infection = $458,140 Example 2: Colon SSI incidence past 12 months = 15 x $20,785 per infection = $311,775 Use APIC HAI cost calculator: https://apic.org/Resources/ Cost-calculators STEP 4: Conclusion including estimated basic ROI for proposed solution (cost of current HAI x 12 months - cost of solution x 12 months = ROI): _________________________________________________________ _________________________________________________________ Example 1: Conclusion including estimated basic ROI for proposed solution: Given the imperative of reducing the CLABSI and CAUTI rates in our ICUs in order to avoid non-reimbursement, negative public perception, and ensure successful CMS and TJC surveys, we recommend addition of 1.0 clerical/analyst FTE. This would allow the expert IPs time to devote to optimizing infection prevention bundles, in order to ensure elimination of preventable infections (60 percent of $458,140 = $274,884). This would then result in a return on investment of $274,884 to $40,000 = $234,884 for the year. Example 2: Conclusion including estimated basic ROI for proposed solution: Given the imperative of reducing the colorectal SSI rate in order to avoid non-reimbursement, negative public perception, and ensure successful CMS and TJC surveys, we recommend approval of implementation of 0.05 percent CHG sterile surgical irrigation solution applied at the end of each case prior to closing, following manufacturer guidelines. This would supplement the current colorectal SSI prevention bundle, to ensure elimination of preventable infections (60 percent of $311,775 = $187,065). When accounting for the cost of the CHG irrigation solution, the resulting return on investment would be $182,065 for the year. TABLE OF CONTENTS 1 TEMPLATE INTRODUCTION ............................................................................. 2 2 EXECUTIVE SUMMARY ................................................................................... 4 3 BUSINESS NEED AND CURRENT SITUATION ................................................... 5 4 PROJECT OVERVIEW ...................................................................................... 6 4.1 OBJECTIVES ....................................................................................... 6 4.2 SCOPE AND OUT OF SCOPE ................................................................ 6 4.3 DELIVERABLES ................................................................................... 6 4.4 STAKEHOLDERS .................................................................................. 6 4.5 RESOURCES ....................................................................................... 7 5 STRATEGIC ALIGNMENT ................................................................................. 8 6 ENVIRONMENTAL ANALYSIS .......................................................................... 9 7 MARKET READINESS .................................................................................... 10 8 ALTERNATIVES (BUSINESS, TECHNICAL, AND PROCUREMENT) .................... 11 9 BUSINESS AND OPERATIONAL IMPACTS ...................................................... 12 10 RISK ASSESSMENT AND ANALYSIS .............................................................. 13 11 FEASIBILITY ASSESSMENT AND ANALYSIS ................................................... 14 12 IMPLEMENTATION STRATEGY ....................................................................... 15 13 CONTRACT MANAGEMENT PROCESSES AND TOOLS .................................... 16 14 PROJECT REVIEW AND APPROVAL PROCESS ............................................... 17 15 RECOMMENDATIONS ................................................................................... 18 16 BUSINESS CASE SIGNOFF ............................................................................ 19 References 1. CDC statistics https://www.cdc.gov/washington/~cdcatWork/pdf/infections.pdf 2. Umscheid CA1, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011 Feb;32(2):101-14. 3. Murphy D et al. Dispelling the Myths: The True Cost of Healthcare-Associated Infections. AJIC. May 2012, Volume 40, Issue 4, Pages 296–303. 4. Zimlichman E et al. HealthCare–Associated Infections A Meta-analysis of Costs and Financial Impact on the U.S. Health Care System. JAMA Internal Medicine Published online September 2, 2013 5. Bartles R, Dickson A, Oluwatomiwa B. A systematic approach to quantifying infection prevention staffng and coverage needs. AJIC. May 2018, Volume 46, Issue 5, Pages 487–491. 6. Oh J. 6 Steps to Make the Business Case for Infection Prevention. Becker's online journal; Oct. 26, 2012. 7. Pyrek KM. Making the Business Case for Infection Prevention. Infection Control Today. February 2011. 8. SCRBD Business Case Template https://www.scribd.com/document/153295718/ Ppp-Business-Case-Template-En FIGURE 1: Example of Simple Business Case – Infection Prevention and Control FIGURE 2 Example of Detailed Business Case 8

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