To address the issue of critical care-associated healthcare-associated infection (HAIs), Cabell Huntington Hospital developed and implemented a sustainable protocol of evidence-based practices, which empowered bedside personnel to reduce central-line associated (CLABSI) infections in the three adult critical care units.
To reduce CLABSI and ventilated-associated pneumonia (VAP) infections to levels based on the National Healthcare Safety Network’s (NHSN) national benchmarks from the CDC’s criteria for teaching hospitals.
Controlling CLABSI and VAP in the adult critical care units had been an area of focus in recent years for Cabell Huntington Hospital. The hospital had been using traditional educational methods, but they had yet to meet their targets for prevention of CLABSI and VAP in these units.
Education efforts were made more difficult by hospital staff turnover and the rotation schedule of attending and resident physicians. In addition, bedside nurses often felt overwhelmed with the multitude of day-to-day processes already required to meet standards and guidelines.
There are four scientific peer-reviewed studies conducted in the past 13 years focusing on identifying and mitigating sterile packaging system-related risks (See Table 1). While each focuses on different aspects of sterility maintenance, all point to the following key considerations:
- When rigid containers are in use, there is potential for instruments to become contaminated during storage and transportation.
- Rigid containers become less effective at maintaining sterility of instruments over time.
- Visual inspection is not enough to identify sterile packaging system sterility risks. The water test is an effective and simple standardized functionality test that can be used in conjunction with visual inspection.
The infection control team wanted to identify a standard of training and education that would resonate with the various groups of professionals working in the adult critical care units and would be more than just another task to get lost in the day-to-day priorities. They recognized that bedside nurses and staff would be paramount to the success of any patient improvement initiative.
The education plan, titled “Infection Inspection” after the hit Sherlock Holmes movie in 2010, was developed to empower the healthcare team in the critical care units to prevent healthcare-associated infections and make all members accountable for achieving the targets. The hospital administration and medical staff supported the concept of ownership in the effort to improve CLABSI and VAP rates.
The team developed evidence-based best practices and an educational program, which was designed to be sustainable over time for continuous improvement.
To launch the educational program, activities planned as part of the kick-off week included breakfast for all staff members and guest speeches by the medical affairs vice president, pulmonary intensivists, critical care director, and infection control team members who provided words of encouragement.
Each unit had a designated “Performance Improvement Champion,” who served as the go-to resource for the unit’s education efforts and also monitored progress. Educational boards were posted outlining the VAP and central line insertion and maintenance bundles. Information booklets were placed in the surgical, adult and burn intensive care units, and information cards were displayed at computer workstations describing the hospital’s VAP prevention and central line insertion and maintenance bundles. Cue cards in each room highlighted the critical elements of preventing infections. More important, staff members were empowered to stop any central line insertion they felt breached sterility criteria outlined in the protocol.
The medical director of the adult critical care unit incorporated daily multi-disciplinary rounds, and included review of central line and ventilator data, to better coordinate patient care across the continuum of care. The team increased activity around evaluations of new products designed to reduce or prevent infections.
For each case of CLABSI or VAP, department leaders, medical directors and infection control staff met to determine the nature of each infection and identify opportunities for quality improvement.
Because of the program’s success, the infection control team has plans to continue “Infection Inspection” events on a yearly basis.
The incidence of CLABSI was tracked starting in May 2010 through November 2010 and compared to the same period the previous year as a benchmark. The chart below indicates the percentage improvement over the same time period the year prior.
|Adult Critical Care Unit||100%|
|Surgical Critical Care Unit||19%|
|Burn Critical Care Unit||43.5%|
The Medical Director of the Adult Critical Care Unit incorporated daily multi-disciplinary rounds to better coordinate patient care across the continuum. This includes line and ventilator data to make sure the hospital can better communicate the patient’s needs.
In addition, the education process now includes cue cards in each room to highlight the critical elements of preventing infections and there are plans to continue and expand our vision and include our “Infection Inspection” as an annual event.