Becker's Clinical Quality & Infection Control

21 PATIENT SAFETY & OUTCOMES Death risk 11 times higher for unvaccinated amid delta spread, CDC finds By Erica Carbajal R elative to vaccinated people, those who are unvac- cinated and infected with COVID-19 face a 10 times higher risk of hospitalization and are 11 times more likely to die from the disease, the CDC's Sept. 10 Morbidi- ty and Mortality Weekly Report found. "Looking at cases over the past two months when the delta variant was the predominant variant circulating in this country, those who were unvaccinated were about four and a half times more likely to get COVID-19, over 10 times more likely to be hospitalized and 11 times more likely to die from the disease," Rochelle Walensky, MD, CDC director, said of the study's results during a Sept. 10 news conference. Researchers analyzed rates of COVID-19 cases, hospital- izations and deaths among adults across 13 U.S. jurisdic- tions from April 4 to July 17, 2021. The report showed that as the highly transmissible delta variant became more prevalent in the U.S., the risk of breakthrough cases also rose, though the vaccines were effective in preventing severe illness. From April 4 to June 19, when delta prevalence was lower, fully vaccinated people accounted for 5 percent of COVID-19 cases, 7 percent of hospitalizations and 8 percent of deaths, overall. When delta prevalence was higher from June 20 to July 17, vaccinated people accounted for 18 percent of cases, 14 percent of hospitalizations and 16 percent of deaths. "Rates of COVID-19 cases, hospitalizations, and deaths were substantially higher in persons not fully vaccinated compared with those in fully vaccinated persons, similar to findings in other reports," the CDC said. n Q: Which patient safety goals are you on track to meet or exceed, and what do you attribute that to? Brian Kaminski, DO. Vice president of quality and patient safe- ty, ProMedica (Toledo, Ohio): Although our serious safety event rate can ebb and flow over time, in the past 24 months alone, we have reduced our rate by approximately 50 percent, coming off a slight increase the previous year. Evidence-based practices, data-driven decision-making and the development of care pathways have enabled our system to deliver safe, high-quality care with limited and rapidly changing informa- tion. We even went as far as converting an existing hospital to care for only COVID-19 patients, capitalizing on an integrated and highly engaged care delivery model. e results of this model are evident in better-than-expected outcomes of our patients and the continued deployment of many of our methods throughout the various waves and surges in our community. Similarly, we are adopting an approach to address surgical site infections specifically. A multidisciplinary, evidence-based practice team has been assembled. ey have reviewed and synthesized the available literature and identified the "dirty dozen" evidence-based practices that have demonstrated a reduction in surgical site infec- tions based on the best research available. e "dirty dozen" will be deployed through an [enhanced recovery aer surgery] platform for specific, high-risk surgical procedures across the system. We hope to see even further reduction in our serious safety events by tackling these infections using evidence-based standards. Dr. Hayworth: One of the many benefits of being in a multispecialty group is that we are able to leverage expertise among many special- ties to inform our clinical policies and guidelines. Most recently, we reviewed and updated our pacemaker policies for CareMount's office-based surgical practices. A working group from the CareMount departments of cardiology and anesthesiology reviewed our current practices and advised, among other things, that leadless pacemakers should be added to the exclusion criteria because these pacemakers do not have a magnet response, rendering them difficult to manage in an office setting. Leadless pacemakers are a relatively new technology and not yet a common consideration in most noncardiology practices. Dr. Christensen: We recently went through a 17-month period of zero central line infections for our entire system. Essentially, we have maintained our zero rates in pretty much all hospital-acquired conditions or have met our improvement goals in all categories of HACs this year. e COVID pandemic did add a layer of complexity to our quality and safety endeavors. Despite this, we have succeeded by making the safety of our patients part of our culture. is has been done through transparency of results, learning from each situation, a nonpunitive approach to improvement and frequent celebrations as milestones are reached. Dr. Lee: Virginia Hospital Center is on track to meet or exceed our safety goals in many areas. For mortality rates, we have collaborated with Mayo Clinic to emulate best practices: a multifaceted approach with strong nursing care, good protocols and procedures and leveraging use of the Epic EHR platform to identify patients at risk for deterioration. We have created rapid response teams, in conjunction with hospitalist medical staff, to intervene. Another initiative we started this year follows patients discharged from the hospital with acute myocardial infarction and heart failure. is can be a challenging population to keep healthy, so we have assigned a nurse to work with the hospitalist physicians to identify patients with these diagnoses. is specialty nurse meets them, coordinates care in- house, and then follows them aer discharge. Anything from place- ment to medication management, physician follow-up, social services and food requirements are assessed and addressed. n

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