Eileen Young, MSN, RN, Assistant Vice President, Clinical Utilization and Outcomes
Eileen Young, MSN, RN
This summer, U.S. Department of Health & Human Services Secretary Kathleen Sebelius upped the ante. She challenged hospitals nationwide to work to reduce healthcare associated infections (HAIs). Citing statistics from the 2008 National Healthcare Quality Report, Sebelius reported that central line associated blood stream infections (CLABSIs) strike hundreds of thousands of patients each year. In addition, patient safety measures have worsened by nearly 1 percent each year for the past 6 years, in part because of the rise in HAIs.
Sebelius called on hospitals throughout the U.S. to commit to reduce CLABSIs in intensive care units by 75 percent over the next three years, and challenged clinicians to use that proven patient safety checklist to significantly reduce the rate of these life-threatening infections. This checklist emerged from the program launched in 2003 and instituted in nearly every intensive care unit in Michigan, known as the Keystone ICU project.
First on the Michigan project’s simple five-step checklist is hand washing, followed by use of full barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site if possible, and removing central lines as early as possible. Within three months of implementation, the rate of bloodstream infections from these IV lines fell by 66 percent. The average ICU reduced its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.
Does it work? Can it be replicated? You bet. We did it. No, you did it!
A CKHS system-wide committee focused on eliminating CLABSI first standardized central line insertion kits and adopted the Central Line Insertion checklist, then instituted a daily Central Line Care Bundle. Over the past two years, through the commitment and vigilance of our nurses, we have cut our absolute number of CLABSIs in half, from 110 in FY 2007 to 56 in FY2009 and cut our central line days by 16 percent across the health system. As a result, our system wide infection rate is 1.5 percent. Four of our ICUs have gone more than 6 months without a single CLABSI; the Crozer MICU, in particular, has gone 26 months!
We have had similar experience in eliminating Ventilator Associated Infections (VAP). About four years ago, the ICUs and vent units across our system adopted the vent bundle of care measures and then added an aggressive oral care regimen with similar astounding success. System wide this past fiscal year, we had 9 cases of VAP! That is 35 less cases of VAP compared to two years ago when we saw 44 cases for a rate of 3.5 cases per 1.000 vent days. Our rate now is 0.9. In the same way, we have seen system wide reductions in MRSA and C diff through the adoption of care bundles and nurse driven protocols.
Let me emphasize an important point. At the foundation of each of these success stories is one key component: the simple act of hand washing. What did we learn in nursing school? Wash your hands before and after every patient contact. It seems so elemental and we have heard it so many times it is easy to become immune to the message. The key to keeping our patients safe, free from infection, doesn’t have to be new or fancy. Turns out, it is pretty basic. As the saying goes, “Just do it!”
Eliminating HAIs, which we now know is a realistic goal, requires diligence on the part of each and every healthcare clinician. Your efforts have saved many patients from harm and, most importantly, saved lives (see “Target Zero Success”). As we celebrate our accomplishments, it is important to stay focused on the basics that will help us move closer to our ultimate goal of zero HAIs. It all begins with hand washing!