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Team Effort Cuts In-Hospital Blood Infections

A combination of best practices, improved safety culture, and a bigger focus on teamwork cut central-line-associated bloodstream infections (CLABSIs) in hospitals by 40%, the Agency for Healthcare Research and Quality (AHRQ) reported.

In preliminary results from a project involving hospital teams at more than 1,100 intensive care units over a 4-year period, the rate of CLABSIs was reduced from 1.903 infections per 1,000 central line days to 1.137 infections per 1,000 line days, the agency said.

Overall, more than 2,000 CLABSIs were prevented, more than 500 lives were saved, and more than $34 million in healthcare costs were avoided, according to AHRQ.

"No patient should ever become sicker as result of care he or she receives," AHRQ Director Carolyn Clancy, MD, said at a press conference Monday. "Until recently, these infections were thought to be an [unavoidable] consequence of care. But they can be prevented."

The program, known as CUSP, centered around four basic concepts, explained Michael Tooke, MD, chief medical officer at Memorial Hospital in Easton, Md., one of the participating facilities. He listed the "4 E's" of the program:

  • Engagement  -  getting the entire staff involved
  • Education  -  teaching the staff about best practices for preventing CLABSIs
  • Execution  -  carrying out the program
  • Evaluation  -  keeping track of the results and feeding them back to the staff

"We also had another 'E'  -  enthusiasm," Tooke said. "We acknowledged every victory - one month without infection, a whole year - and had a party for every one."

Components of the program include a procedure checklist, educating staff members on best practices, and trying to change the culture so that infections are considered unacceptable, said Peter Pronovost, MD, PhD, senior vice-president for safety and quality at Johns Hopkins Medicine and one of the developers of the CUSP system.

Pronovost explained that he was inspired to tackle the CLABSI problem after a pediatric patient at the hospital died from what he described as "a cascade of errors starting with a central line bloodstream infection."

"We set out to change this - it worked," Pronovost said. "We virtually eliminated these infections at Hopkins." Since the program started, many hospitals now "have infection rates previously believed impossible."

Theresa Hickman, RN, of Peterson Regional Medical Center in Kerrville, Texas, said one of the changes the program wrought at her hospital was making sure physicians washed their hands before inserting a line. "We made it so that if the nurse did not see a physician washing hands prior to the procedure, it was considered that the physician didn't wash his hands," she said.

Hickman noted that her 125-bed rural hospital has not had a CLABSI in its entire facility for 31 months. "Before this, having CLABSIs was part of the price of doing business. Now we know that's not true, and we can keep patients from dying," she said.

Source: Joyce  Frieden, News Editor, MedPage Today-Published: September 10, 2012

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