Behind every health care-associated infection is a patient and family whose lives are affected. Thus, when seven CMS Quality Improvement Organizations (QIOs) were approached by the Centers for Disease Control and Prevention (CDC) to conduct a pilot to reduce catheter-associated urinary traction infections (CAUTI), they jumped at the chance.
Under the pilot program – conducted in 2014 – the QIOs used CDC’s Targeted Assessment for Prevention (TAP) strategy, a metric-based system for identifying and targeting facilities with the greatest need for improvement. During the project, QIOs sought to test the feasibility of the TAP approach and develop tools for targeted implementation of prevention and intervention activities within their respective states.
“Hospitals tend to provide generalized education to all of their clinical areas,” said Rick Welsh, RN, CPHQ, lead HAI quality specialist in Florida for Health Services Advisory Group (HSAG), a participant in the pilot and the current QIN-QIO for Arizona, California, Florida, Ohio and the Virgin Islands. “However, no two hospital units are alike – each has different cultures and needs – so a one-size-fits-all approach is not the answer. The TAP strategy allows us to collect current National Healthcare Safety Network (NHSN) data to identify specific units that have excess infections. Hospitals can then utilize the CAUTI assessment tool to determine potential gaps and individualize interventions and education based on the specific needs of those units.”
During its pilot project, HSAG helped test the CDC’s statistical code and produce TAP reports that enabled the QIO to identify those hospital units with the most need for HAI reduction. HSAG then provided the hospitals with the CAUTI assessment tool to determine which infection control domains those units were struggling with the most. HSAG asked hospital staff to answer a series of questions in six different domains, including general infrastructure capacity. Welsh said that five hospitals in Florida participated in the TAP pilot project, submitting over 100 assessments, which HSAG provided to the CDC for technical assistance with analysis and feedback of the results. Welsh noted that within some hospitals, two separate units submitted CAUTI assessments that indicated there were different educational needs, demonstrating that HAI reduction requires a customized approach.
Presently, HSAG is determining which hospital units have the highest number of infections and will use the CAUTI assessment tool to determine in which areas they are most struggling. Based on those findings, HSAG will provide targeted, evidence-based educational tools to help the hospitals reduce their HAI rates.
“The TAP strategy is a game changer,” said Welsh. “It enables us to provide targeted information to those units that need it the most.”
Based on this successful pilot, the CDC is expanding its partnership with the QIO Program to enable all QIN-QIOs to use the TAP strategy for prevention of CAUTI, Clostridium difficile and central line-associated blood stream infection (CLABSI). Ultimately ,the goal is to create an integrated assessment and implementation guide for all HAIs, so QIN-QIOs have an accurate snapshot of prevention efforts at specific facilities and can determine how best to proceed with reducing HAI rates.