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Multi-Drug Resistant Organisms (MDROs) MDROs, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), have important infection prevention implications in all healthcare settings. Because the severity and extent of disease caused by MDROs varies by the patient population and type of care setting (e.g., long-term care facility, intensive care units), the approaches to prevention and control need to be tailored to the specific needs of each population and individual institution. The prevention and control of MDROs is a national priority – one that requires that all healthcare facilities and agencies assume responsibility. CMS Hospital-Acquired Conditions (HAC): What You Need to Know CMS HAC In the final FY'08 IPPS rule, CMS identified ten hospital-acquired conditions (HAC) for which hospitals will not receive the higher DRG payment for care, beginning October 1, 2008, if they were not present at admission. These include three healthcare-associated infections, expanding SSI from mediastinitis to two more types. Healthcare-Associated Infections • Catheter-associated urinary tract infections (CAUTI): The ICD-9 code does not distinguish between catheter-associated infection and inflammation. Use of present on admission (POA) codes will be important • Vascular catheter-associated infection — CLABSI and local infection: CMS has a central vascular catheter (CVC) code in place 999.31. This code includes local and systemic infection and inflammation. Use of POA codes will be important and CVC infections are not limited to the ICU • Surgical site infection • Mediastinitis after CABG surgery: This infection has a specific complication code. 519.2 (MCC) plus 1 Procedure codes: 36.10-36.19 • Selected orthopedic surgeries: Spinal fusion and other surgeries of the neck, shoulder and elbow • Bariatric surgery for morbid obesity: Laparoscopic gastric bypass and restrictive surgery and gastroenterostomy Safety Culture The HAI Elimination Program is part of the overall safety and quality improvement program. A culture of safety that empowers and supports staff in their efforts to reduce risks and improve patient care is the key to success. A number of tools and resources are available to assess the safety culture of an organization Measures to Prevent HAIs • Hand hygiene: Hand hygiene by healthcare personnel is considered one of the most important strategies to prevent patient-to- patient transmission of organisms causing HAIs in the healthcare setting. • Bundling — evidence-based practices: There has been dramatic success in improving the quality of patient care by focusing on the implementation of an entire group or bundle of evidenced-based practices to achieve a better outcome than when implemented individually. This process is referred to as "bundling" of evidence-based practices. The science behind each element of the bundle is well established that its implementation is considered a generally accepted practice. (See bundle chart on the following page) Provider Education Training Manual 4 |

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