By Jennifer Larson, contributor
June 5, 2013 - The medical–surgical intensive care unit at HealthEast Care System-St. John’s Hospital in Minnesota hasn’t logged a central line associated-bloodstream infection (CLABSI) in more than three years.
“We now have gone 38 months without a single one,” said ICU clinical director Cindy Geary, RN, BSN. “That’s a pretty amazing statistic.”
For their successful effort to prevent their vulnerable patients from getting one of the potentially deadly healthcare-associated infections (HAIs), Geary and her team received an award from the Critical Care Societies Collaborative (CCSC) and U.S. Department of Health and Human Services in May.
Seven other hospitals and healthcare facilities were also honored for their success in preventing or eliminating HAIs, specifically in critical care settings, as part of the 2013 National Awards Program to Recognize Achievements in Eliminating Health Care-Associated Infections. The CCSC is comprised of the American Association of Critical-Care Nurses (AACN), American College of Chest Physicians (ACCP), American Thoracic Society (ATS) and Society of Critical Care Medicine (SCCM).
These awards recognize that sustained efforts make HAI reduction and elimination possible.
Why reducing HAIs is critical
HAIs are a common complication from hospital care. One out of every 20 hospitalized patients will contract an HAI, according to the Centers for Disease Control and Prevention (CDC). The most prevalent HAIs are, in order of prevalence, catheter-associated urinary tract infections (CAUTIs), surgical site infections, bloodstream infections and pneumonia.
And HAIs are costly. Not only are they among the leading causes of death of hospitalized patients, according to the National Action Plan to Prevent Healthcare-Associated Infections, but the overall annual cost to U.S. hospitals of these preventable infections could be as high as $33 billion.
In response to the growing problem, the national action plan was launched in 2009, with phase one concentrating on acute care hospitals. Nine five-year HAI reduction goals were outlined, along with metrics and measurement systems to assess progress toward the goals.
In order to win one of the CCSC awards, a health care facility had to demonstrate at least 25 months of success in reducing or eliminating infections such as CLABSIs, ventilator-associated pneumonia (VAP) or CAUTIs.
HHS Deputy Assistant Secretary Don Wright, MD, MPH, noted in a statement that the efforts of these teams and others are responsible for the progress that’s been made toward achieving the national action plans’ 2013 national targets.
Sustained attention required
Facilities are finding that successfully eliminating these infections takes commitment--serious, sustained commitment.
“Over the awards program’s three years, we’ve repeatedly seen three important elements of success: consistency, coordination and collaboration,” said AACN senior director Ramon Lavandero, RN, MA, MSN, FAAN. “Consistency in how solutions are carried out over time; the awardee institutions have been at this for years. Coordination so the solutions are implemented across all affected patient care areas. Collaboration that involves all relevant health professions.”
“It certainly didn’t happen by accident,” said Geary of her hospital’s success. “Nor did it happen overnight.”
Prior to eliminating CLABSIs more than three years ago, the medical–surgical ICU at St. John’s Hospital was averaging about eight cases per year. But the facility implemented a three-pronged approach that included standardized line carts for each room, standard physician procedure notes kept on the carts, and a change to the dressing and cleaning of the insertion site. It was a plan carefully researched and implemented.
Collaboration between the physicians, nurses and the infection control and prevention department was a central part of the strategy. “It’s not just because of one person or one entity,” said Geary.
The intensive care unit at Franciscan St. Francis Health in Mooresville, Ind., has not had a CAUTI since 2010.
“It’s an ongoing process,” said Tara Simon, BSN, CCRN, manager of the intensive care unit, Franciscan St. Francis Health-Mooresville.
A team from the Mooresville hospital and its two sister hospitals collaborated on catheter management issues, reviewed the literature and information from the CDC, and developed six guidelines, which were implemented around the end of 2010. After an educational blitz to get everyone up to speed, each unit decided how to embrace the changes and make it part of their culture.
Novant Health has worked hard to maintain a stellar record over the last few years, as well. Three Novant ICUs were awarded for their excellence in eliminating ventilator-association pneumonia infections. In fact, mixed bed ICUs at both Novant Health Matthews Medical Center and Novant Health Huntersville Medical Center have surpassed the six-year mark.
Cheryl Crutchfield, RN, director of critical care program development for Novant Health, says consistency and ongoing training have helped their facilities eliminate ventilator-associated pneumonia.
“It’s really been a process of best practices and working at it and training at it,” said Cheryl Crutchfield, RN, director of critical care programs development for Novant Health.
Empowering nurses plays a part
As Simon noted, there may be some culture change required in order to achieve set goals. Among other activities, her hospital held regular journal clubs so nurses could learn about and discuss the evidence behind some of the changes that were made in the pursuit of infection elimination.
And empowering nurses is one of the keys to success.
It can be tempting to stay quiet when a doctor is in a hurry and skips a step, but leaders point out that nurses must feel comfortable speaking up in those situations--and hospitals must support them in doing so. At HealthEast Care System-St. John’s, the nurses participated in role-playing exercises during staff meetings so they would feel empowered to halt a procedure until all the necessary precautions had been taken.
“They used to come out of a room when these barrier precautions were not used, and they’d feel like they had failed. But they didn’t feel it was in their control to really tell somebody else how to practice,” Geary said. “So [we explained] that it’s a team effort and we all have a responsibility for the care of the patient and then taught them politely and tactfully how to approach a doctor and say, ‘May I help you with your gown?’ or ‘What size gloves would you like?’”
Crutchfield added that it’s important to encourage nurses to practice at the top of their license. There are many tasks that can be delegated to free up nurses to manage the care and needs of their patients.
During the change process, organizations may want to consider barriers and potential barriers to infection reduction. Said Simon: “As you roll things out, what are the things that are preventing people from being compliant?” By considering barriers that might exist, an organization may be able to easily eliminate certain things that will make a noticeable impact on infection reduction.
The full list of CCSC’s 2013 National Award Recipients, recognizing achievements in eliminating health care-associated infections:
- Intensive Care Unit, Franciscan St. Francis Health, Mooresville, Ind. (CAUTI)
- Surgical ICU and Trauma Burn ICU, University of Michigan Health System, Ann Arbor (VAP)
- Medical Surgical ICU, HealthEast St. John’s Hospital, Maplewood, Minn. (CLABSI)
- Beth Israel Medical Center, New York, N.Y. (CAUTI)
- ICU, Novant Health Presbyterian Medical Center, Charlotte, N.C.; ICU, Novant Health Matthews Medical Center, Matthews, N.C.; and ICU, Novant Health Huntersville Medical Center, Huntersville, N.C. (VAP)
- Cardiac Intermediate Unit, East Carolina Heart Institute at Vidant Medical Center, Greenville, N.C. (CLABSI)
- Medical Intermediate Unit, Vidant Medical Center, Greenville, N.C. (VAP)
- Medical University of South Carolina, Charleston (CLABSI)
Universal Decolonization Decreases ICU Infections
A recent study published in the New England Journal of Medicine compared targeted treatment to universal decolonization to reduce infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in ICUs in 43 hospitals.
Universal decolonization of ICU patients resulted in a 37 percent decrease in MRSA-positive clinical cultures and a 44 percent decrease in bloodstream infections from any pathogen.
“We found that universal decolonization prevented infection, obviated the need for surveillance testing, and reduced contact isolation,” wrote the study authors. But, they cautioned, “If this practice is widely implemented, vigilance for emerging resistance will be required.”
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