Page 17 - Experiential_Learning_Guide_6-30-2017a_Flat

their charts indicated cause for alarm. Drill down into their processes demonstrated that staff was not
following all evidence based best practices. Additional education was an opportunity and resources
were made available. As a result, the surgical floor went eleven months without another CLABSI.
Infection rates are routinely collected for targeted healthcare and community associated infections.
Surveillance data are analyzed and rates calculated. Examples of these include incidence rates such
as CLABSI rates (# of CLABSI/number of central line days x 1000) and CAUTI rates (# of CAUTI/
number of urinary catheter days x 1000). Prevalence rates have also been obtained through a rounding
opportunity of one day and assessing central line dressings and alcohol impregnated endcaps in place
(# of appropriate dressings or alcohol endcaps in place in hospitalized patients today/# of patients with
central lines today).
Rates and Antimicrobial Resistance Patterns

Incidence rates or new infections of certain healthcare associated infections are presented quarterly
to the Infection Prevention Committee and monthly to the Patient Safety Performance Monitoring
Committee. A review of the rate is described, such as what is included in the numerator and
denominator. As mentioned previously, these rates are included in the infection prevention risk
assessment. The risk assessment includes the risk, the probability of the risk occurring, the severity
of the risk if it happens, and what level of mitigation strategies are in place for preventing the risk.
The risks are multiplied and a score is obtained. The higher the chance of the risk occurring, having
catastrophic results, with poor prevention measures or none in place will contribute to a higher score
which creates a priority goal. Additional risk assessments include construction risk assessments and
the CDC’s tuberculosis risk assessment.

Antimicrobial resistance has become a problem, particularly among hospitalized patients. The
detrimental impact of antibiotic resistance on the treatment outcome of healthcare-associated
infections has been well documented in terms of increased morbidity and mortality, as well as
increased healthcare costs (Arnold, 2014, p. 26-10). As a result of this increasing problem, I initiated
an Antimicrobial Stewardship Committee in the spring of 2015. Baseline information was collected
that demonstrated the overuse of antibiotics when clinically not necessary. An analysis of 3 months
of positive urine cultures with corresponding chart review revealed that 62% of patients were possibly
unnecessarily treated with antibiotics for asymptomatic bacteriuria in the absence of clinical signs and
symptoms of urinary tract infection.

www.americansentinel.edu

17
Experiential Learning Portfolio Guide |