After reading this article, you will be able to:
- Identify the 2008 infection rate at University Hospital
- Describe how staff members reduced the infection rate to zero
- Explain why public reporting is beneficial
On June 31, the New York State Health Department released a report detailing the healthcare-associated infection (HAI) rates of hospitals in New York for 2008. SUNY Upstate University Hospital in Syracuse, NY, reported an alarming infection rate in the medical-surgical ICU. According to the report, University had a central line–associated bloodstream infection rate of 8.3 per 1,000 patient days in that particular ICU during the previous year. The state average in New York was 2.3.
The report forced University’s quality team to reevaluate its processes for infection prevention, particularly in the ICU, says Judy Kilpatrick, RN, clinical nurse specialist to the surgical ICU, trauma, and burns. Part of Kilpatrick’s job is to examine quality measures and determine what the hospital can do to improve direct patient care at the bedside.
“I think there were a number of contributing factors, and the way our system was set up, that didn’t afford an easy process for the practitioner to do the right thing,” Kilpatrick says. “When I talk to my colleagues, they have the same particular issue, so what we did is we implemented some things that would make it more efficient for the practitioner and at the same time institute some documentation procedures, which allowed us to go back and coach those people through the [Institute for Healthcare Improvement (IHI)] bundle.”
University kick-started a fast-paced improvement program to reduce central line infections in all ICUs throughout the facility. One year later, the hospital has reduced its rate to zero, says David Duggan, MD, medical director and quality officer.
“We have tried to look for solutions that make it easy for people to do the right thing, and I think that’s the key,” Duggan says.
Why the rate was so high
Duggan explains that although infection control (IC) improvements have helped lower the HAI rate in the med-surg ICU, one of the primary reasons the rate in this particular six-bed unit was so high was because it was part burn unit and part general ICU.
“Burn units, when they are standalone units, are actually excluded from this measure because infections are so common in patients with burns,” Duggan says. “This unit was included because it did not have the majority of patients with severe burns, but still there was a component of the population there that was extraordinarily susceptible to infections.”
Shelley Gilroy, MD, hospital epidemiologist at University, explains that burn patients have an indigenous flora which results in more infections. “That’s why they are considered a high-risk group, and why we might have had an increase in the rate,” says Gilroy.
The unit was included on the report because it was technically a general ICU, but the numbers didn’t account for these susceptible burn patients, Duggan says. Still, a published infection rate that was almost three times higher than the state average elicited a primary focus on IC.
The initiatives have worked thus far. Through the second quarter of this year, University has posted infections in just three of its seven ICUs, all of which fell below the state average for each unit. So far this year, the med-surg ICU has posted zero infections.
Implementing the bundle
At the beginning of the year, University formed a multidisciplinary group of roughly 12 people with the task of implementing the IHI’s central line bundle. The group developed forms and documentation that included a checklist, one of the major parts of the bundle.
“During the procedure, it brought everyone together on agreed-upon techniques, such as not starting without the equipment necessary, the staff all communicating and staying in the room together during the procedure, and having the right equipment at the right time to do the job,” Kilpatrick says.
The group also implemented procedure carts for maximum barrier precautions to ensure that all the required equipment was at the bedside during the procedure.
All new residents and employees receive education about the bundle process, and the hospital has plans to implement its own bundle that will educate employees who provide central line maintenance.
“Everything in that bundle has been incorporated into practitioner education,” Kilpatrick says. “We hope over the next year to make up our own concept, which is called a maintenance bundle, to review with the people who are doing the dressings and maintain the catheters so we can keep that cleanliness throughout the catheter’s life.”
Adapted from Briefings on Infection Control, December 2009, HCPro, Inc.