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New York hospital reaches 1,000 days without CLABSI


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New York hospital reaches 1,000 days without CLABSI

Glen Cove Hospital hits a milestone for infection prevention in the ICU

After reading this article, you will be able to:

  • Explain how Glen Cove’s ICU reached 1,000 days without a CLABSI
  • Recognize the importance of motivating staff members
  • List important data to share with staff and leadership

In September, the New York State Department of Health released a report that listed infection rates for each hospital in the state. The report noted that there has been an 18% reduction in central line–associated bloodstream infections (CLABSI) in New York state ICUs dating back to 2007.

A major contributor to that decrease has been Glen Cove Hospital, which has maintained a rate of zero CLABSI infection rates for nearly three years. 

On September 19, shortly after the report was released, Glen Cove celebrated its success, marking the 1,000th day that the hospital’s medical-surgical ICU has gone without a central line infection.

“This is a tremendous achievement and I applaud our dedicated staff members who have made Glen Cove Hospital a safer environment for our patients every day,” Dennis Connors, the hospital’s executive director, said in a press release. “We are celebrating this milestone but we are firmly focused on continuing our diligence to prevent central-line infections in the ICU.”

 

The beginning of the streak

Glen Cove began its initiative for zero CLABSIs in 2005, when the facility began concentrating on the Institute for Healthcare Improvement’s initiative to reduce HAIs, including CLASBI, pneumonia, surgical site infections, and MRSA, according to Jeanine Woltmann, RN, BS, CIC, manager of epidemiology at Glen Cove.

Glen Cove revamped its procedures by changing its daily forms to include the following measures:

  • Does the patient need a central line?
  • When was the dressing changed?
  • What does the site look like?
  • Can the patient be transferred to oral medication?
  • Can the line be taken out?

 

“Initially, aside from all the education that was done, we developed a bundle approach and various forms that needed to be completed,” Woltmann says. “It was very much leadership reinforced and supported to make sure that everybody was doing everything by the book.”

 

Support from leadership

Leadership at Glen Cove was the first to develop the idea of reducing central line infections within the North Shore-Long Island Jewish Health System, which is made up of 13 hospitals, says Brian Pinard, MD, chief of surgery at Glen Cove.

“One of the aspects of this was the leadership—not just here in the hospital with the leadership of the nursing staff and the ICU, but the leadership from the system,” Pinard says. “People who are executives and physician executives decided that this is something we need to pay attention to and this is the way that we need to get our arms around it; therefore, everybody needs to start doing it.”

Pinard says that Glen Cove has also been willing to look at how other hospital systems prevent infections in order to improve the procedures at its own facility. Hospital leadership would select the appropriate people to implement effective procedures and even fly staff members to talk to another group or system to understand how their processes worked.

The unit leadership also meets to look at collected data and find deficiencies and areas for improvement. 

“So that’s really how it works, and I think early on they saw that this was important and kind of pushed it out to everyone else,” Pinard says.

 

Changing attitudes

A systemwide change in infection prevention practices usually means reforming the behavior of staff members who may be set in their ways.

The IP’s job is to change that old behavior in order to adapt to the proven evidence-based practices that will reduce infections.

“To have someone come along and tell them, ‘You’ve been doing it this way, but we want you to do it this way because that’s going to work out better,’ that’s something that’s very, very difficult,” Pinard says. “I don’t think that’s something the public knows about, but those were huge changes as well as changing the behavior of some of the physicians and getting them to buy in.”

Part of changing those attitudes is acting as a consultant, explaining what specific methods need to be adopted and personalizing the changes to suit your facility. Pinard suggests compiling data that are unique to your facility, including infection rates, patient days, and how many patient lives are put in danger as a result. Then find other hospitals that have found success by implementing proven recommendations from national organizations.

“Bring the evidence in, the hard and cold evidence, and then physicians and medical practitioners are extremely competitive,” Pinard says. “We aren’t going to want to have a hospital X, Y, or Z be better than we are.” Once one or two physicians are on board, the rest will quickly follow, he adds.

 

Empowering nurses

A key factor in reducing CLABSIs is giving nurses the authority to stop a central line insertion or remind a doctor if he or she has skipped a step in the checklist. 

“Some of the nurses felt a little intimidated, but you also have the nurse leadership in the unit, who was not intimidated and would stop the process,” says Woltmann. “And once you do that once or twice, they changed, and it really did make a difference.”

Glen Cove uses two forms during the insertion of a central line, Woltmann says. One is for the doctor who is putting in the line, which acts as an insertion checklist; the second is a team checklist for the nurses and other staff members in the room, which ensures that the doctor follows protocol, such as washing his or her hands or donning the appropriate PPE.

These checklists are developed by experts within the system, Pinard says. The forms are approved by the medical board, which gets physician leadership involved; they are then put into practice.

“There’s a checks and balances [system] initially right at the bedside,” Pinard says. “These forms were developed at the system level by groups of people with interest and qualifications to develop these forms.” 

 

Keeping staff motivated

The hardest part of achieving a milestone such as 1,000 days without a central line infection is sustaining the success and keeping staff motivated and focused in order to maintain the streak.

Maintaining consistency is derived from the airline industry, Pinard says; the checklists used resemble airline protocol in which pilots are required to check and confirm each component before taking off. 

“Medicine is big these days on touting the benefits of these airline training and maintenance procedures,” he says. “And one of the problems has always been not just establishing a checklist and the way of doing things {e.g., a bundle}, but paying attention to it and keeping that level of awareness and excitement about it.”

One of the keys to motivating staff from the start—and keeping them motivated—has been to publicize the infection rates on a regular basis and compare those rates to the other facilities within the system and within the state, Pinard says.

“Part of the maintenance is keeping people revved up and publicizing sometimes how poorly they are doing or, vice versa, how well they are doing,” he says. “It’s a self-perpetuating thing. Once the snowball starts rolling, you want to keep it rolling, and I think that’s a big part of it.”

On the 1,000th day without an infection, the hospital held a ceremony, which included a lunch for the staff members as well as systemwide recognition for their accomplishment.

Now that they’ve hit the mark, staff members are very conscious of their success, and nobody wants to be the one to break the streak, Pinard says. Staff members are eager to receive the information and figures to verify that they are still at zero infections.

“That’s the key to the whole thing—you’ve got to keep the fire lit under people because nobody wants to be the one that screws it up,” Pinard says. “Because you know whoever screws it up, their name is going to be out there.”

 

The role of an IP in maintaining zero infections

Much of the responsibility to implement zero infections falls to the IP. 

Jeanine Woltmann, RN, BS, CIC, manager of epidemiology at Glen Cove (NY) Hospital, reviews all of the laboratory results daily. She reviews any positive result to see what the source of the infection could be and whether it is the result of a central line.

Woltmann then makes daily rounds not only to ensure compliance with the central line bundle, but also to ensure that all basic IC measures are being met, such as hand hygiene, proper use of PPE (especially if the patient is on isolation precautions), and insertion or handling of central lines.

Woltmann tracks compliance with the central line bundle, and those data are shared across the hospital system. She meets monthly with nurse managers and unit managers, but the information is also presented to the medical board and to the 13 other hospitals within the system.

“She is the initial runner, and whatever she is putting down on her piece of paper has another life not only within the department of health and nationally, but it has another life within the system,” says Brian Pinard, MD, chief of surgery at Glen Cove.

If there are IC problems or complications, Woltmann is responsible for determining why the infection occurred and where there is room for improvement. “Whenever we do have any potential issue—a possibility where we question whether it was or wasn’t [an issue], or if we do have a line infection in a non-ICU area—we perform a root cause analysis and do a detailed investigation as to why this happens and what can we do to prevent this again,” she says.