Clinicians must understand both the clinical and financial impact of health-care-acquired infections to foster the necessary will and resources to change practice. This session addresses the magnitude of the problem, how HAIs fit into the current reimbursement structure, and the interventions that can help save patients’ lives.

To successfully prevent health-care-acquired infections, clinicians must know how microorganisms are transmitted within a care setting, as well as how we screen and measure that transmission. With that knowledge, the caregiver can make the necessary changes in their practice and help to control the sources of infection.

The hands of health care workers are lethal weapons. They are the number one source of transmission of microorganisms. With greater knowledge of the evidence-based practices to address hand hygiene and environmental cleanliness, the caregiver will be an active part of the solution versus a contributor to the problem.

The patient’s flora, as well as inserted devices, can serve as a portal to infection. Learning global source control measures to reduce microorganisms on the patient’s skin through evidence-based bathing is key to controlling bacterial load in the environment.

C-diff transmission in hospitals occurs primarily from contaminated environments and through the hands of healthcare personnel. A 2011 CDC surveillance study found that C-diff caused almost half of a million infections and directly led to approximately 15,000 deaths in one year with an estimated cost of 4.8 billion. The impact of C-diff is discussed, along with one of the major risk factors: overuse of antimicrobial therapy.

Rapid diagnosis will lead to prompt treatment and implementation of contact precautions that can limit the spread of C-diff in the environment of care. The best testing methods and culturing practices will be outlined to prevent over or under diagnosis.

C-diff prevention efforts should focus on community- and facility-based antimicrobial stewardship and preventing disease transmission. The foundation of an antimicrobial stewardship program is outlined. Hand hygiene and environmental cleaning standards, as well as methods for stool containment, are discussed.

Twelve to sixteen percent of adult inpatients will have a urinary catheter at some time during their hospital stay. CAUTI complications can cause discomfort for the patient, increase hospital length of stay and health care costs, and impact mortality. This session addresses the magnitude of the problem, the risk factors for development, and how CAUTIs fit into the current reimbursement structure.

Assessment of need for a catheter should be based on criteria that are clearly defined. It is challenging to break through routine practices for catheter placement in ERs, ORs, and ICUs that have existed for years. This chapter will examine the process around the decision to insert a catheter, the use of alternatives, and the procedure for insertion.

Maintaining the catheter using evidence-based practices includes: care of the catheter during bathing and fecal incontinence episodes, culturing practices, and nurse-driven early catheter removal programs. When practiced together in a robust safety culture, these maintenance interventions can significantly reduce CAUTIs.

The last CAUTI prevention national published guidelines from the CDC occurred in 2009, and the infectious disease and hospital epidemiologist as well as the infection preventionist groups latest updates occurred in 2014. The creation of new evidence and technology is evolving at a rapid pace, and this chapter will outline all the latest innovations that go beyond the guidelines.

An estimated 30,100 CLABSIs occur in U.S. intensive care units each year with up to 250,000 occurring across care settings. Patient mortality rates associated with CLABSI range from 12 to 25 percent, and the cost ranges from $3,700 to $36,000 per episode. During this session a review of the magnitude of the problem, the risk factors for development, as well as how CLABSI’s fit into the current reimbursement structure, are outlined.

The insertion bundle is discussed and includes recommendations for aseptic technique, location of the line placement, and cleansing of the site. The bundle, when implemented successfully, significantly reduces infections. The addition of a checklist to the procedure results in patients being more likely to receive the appropriate care each time the procedure is performed.

The maintenance bundle is outlined, which includes type of dressing, dressing change frequency and care, accessing the port, and intravenous line changes. When practiced together in a robust safety culture, the bundle can significantly reduce or eliminate CLABSIs.

The last national published CLABSI prevention guidelines from the CDC occurred in 2011, and the infectious disease and hospital epidemiologist as well as the infection preventionist groups latest updates, occurred in 2014. The creation of new evidence is evolving at a rapid pace, and this chapter will outline all the latest innovations that go beyond the guidelines.

In order to establish more objective surveillance criteria, the CDC transitioned from ventilator-associated pneumonia to ventilator-associated events (VAE) in adult acute care hospitals and in long-term care hospitals. VAE surveillance detects a broader range of conditions. In this chapter, the three types of VAEs are discussed.

A large number of patients who were on mechanical ventilation in the ICU experience physical disabilities, challenges in cognitive function, and mental health issues. Twenty to eighty percent of ICU patients have delirium during their time in the ICU. This contributes to cognitive impairment as well as depression and PTSD that can persist for years. This chapter explores the long-term effects of mechanical ventilation and ICU if the correct prevention strategies are not put in place.

The original ventilator bundle was created in the early 2000s to help prevent injury associated with being on a mechanical ventilator. In this chapter, the prevention strategies to reduce risk of aspiration, stress ulcers, and deep vein thrombosis are discussed. The next two chapters will outline the evolution of a larger bundle that improves overall care of the ICU mechanically ventilated patient.

The ABCDEF bundle extends the original VAP bundle and was developed to improve the health of ventilated patients by reducing the risk of oversedation and immobility, improving patient comfort, reducing the risk of infection, and decreasing the risk of mental status changes and long-term morbidity. In this chapter, we will discuss the ABC portion of the ABCDEF bundle: Assess and manage pain, Both spontaneous awakening trial and spontaneous breathing trial, and Choice of sedation.

The ABCDEF bundle extends the original VAP bundle. In this chapter, we will discuss the DEF portion of the ABCDEF bundle, which helps the clinician assess and manage delirium and implement an early progressive mobility program while engaging the patient and family in the journey.

In a recent national survey, an estimated 722,000 hospital acquired infections (HAI) occur in the hospitals annually. Approximately 75,000 deaths occur yearly with one out of every 25 patients developing an HAI during hospitalization. Tied for the number one infection is non-ventilator hospital acquired pneumonia. This chapter will define non-vent HAP and present data on the scope of the problem in U.S. hospitals.

There are two major categories of risk factors for development of HAP, a bacterial burden large enough to create an infection, and then micro or macro aspiration of the bacterial burden. This chapter will review the major risk factors to help the learner understand the importance of the prevention strategies.

This chapter discusses the recent research around implementation of a comprehensive oral hygiene to reduce non-ventilator health care acquired pneumonia. Mobility and airway clearance strategies will also be outlined.