3. Surveil outcomes and processes together.
By doing this, you’ll “have two beautiful sets of data for one effort,” Dr. Conway explained. “So, for instance, CAUTI and device utilization; you double the utility of collecting denominator data. Honestly, CAUTI is almost never the priority, but it is for our regulators; priority is usually device utilization [and] catheter utilization, so monitor them together.”
4. Accept any target that a clinician is already motivated to improve.
What are the benefits to doing this? Dr. Conway explained, “This saves you time, because as you know, half your time as an IP, or hospital epidemiologist, is spent convincing people that this is important to monitor, that it is important to use the monitoring data and act on it to reduce infections.” She added, “Well, if they are already halfway there, then just jump on the wagon with them.” She provided attendees with an example of how, at her own facility, external ventricular drain (EVD) infections were higher than they wanted it to be. However, according to Dr. Conway, she had a clinician group (ranging from nurse practitioners to nurse educators to intensivists to neurosurgeons) who were “highly motivated” and all wanted the same thing: to reduce EVD infections. Also, the clinician group already suspected certain risk factors or practices. “So, all I needed to do was come in and support them. I helped them find benchmarks for outcome surveillance. I helped them identify best practices for the process of surveillance, because that’s where my expertise lies… They give me a ton of contextual information that I barely have to ask for,” Dr. Conway said. “And goal setting; they set their goals themselves, almost. So, I think this is a really wise use of our resources at this setting.”
She concluded, “We all know that surveillance is very labor-intensive; it uses a lot of our resources and our resources are limited. Regulators do dictate some surveillance activities, but a surveillance plan, our own plan, should be based on our own risk assessment in our own location, and there are some options that I’ve suggested for sufficient surveillance.”
By taking advantage of some of these options, infection preventionists and hospital epidemiologists alike can “pick their battles" and make the most of their time in resource-limited settings.
2017 SHEA Spring Conference
Picking Battles: Balancing ICRA versus Regulatory Mandates
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