The Beth Israel Brooklyn ICU team, from left, includes Lisa Cohen, RN, director of patient care services; Hosam Sayed, MD, intensivist; Patricia Attreed, RN; Alexis Raimondi, RN, infection preventionist; and Abigail Kristt, RN.
The U.S. Department of Health and Human Services and the Critical Care Societies Collaborative considers eliminating hospital-acquired infections a priority. They recently recognized hospitals around the country for successful efforts, including two in New York.
Beth Israel Medical Center in New York and Brooklyn received a 2012 Outstanding Achievement and Leadership Award for its work in reducing central line-associated bloodstream infections, and Stony Brook University Medical Center in East Setauket, N.Y., came home with a 2012 Honorable Mention Award for its progress in reducing ventilator-associated pneumonia. Both hospitals used a collaborative, multidisciplinary approach to reducing infection rates.
Beth Israel Medical Center
Beth Israel began its CLABSI initiative in 2004 in the medical ICU and since has expanded it to additional units at both of its hospitals. Consistently following evidence-based care bundles, such as using appropriate hand hygiene, maintaining a sterile field with full-barrier precautions and prepping the skin with chlorhexidine, has contributed to bringing the rate of infection down.Lisa Sokoloff, RN
“Its a team working together,” said Mary Walsh, RN, MSN, NEA-BC, CEN, vice president of patient care services and CNO. “You cannot win a battle like this if its just one discipline.”
Nursing and infection control staff educated front-line nurses about the protocols and the research that supports following them. The hospital has developed checklists and insertion and maintenance kits with all of the supplies needed at the bedside. Staff members are empowered to speak up if any step in the process is skipped.
“Nurses feel comfortable, and even the PCAs will stop a physician who didnt wash his hands,” said Ina Jabara, RN, MS, nurse manager of the MICU in Manhattan.
Beth Israel brought its CLABSI rate down from 4.5 infections per 1,000 device days in 2004 to 1.3 in 2011 and reduced the median duration of central-line use from 10 days to 1.7.Photo courtesy of SBUMC
The Stony Brook University Medical Center SICU team includes, back row, from left, Kelly Brady, RN; Moira Squires, RN; Stacy Townsend, RN; John Liguori, RN; Steve Cuce, RT; physician James Vosswinkel, SICU director; and Henry MacLellan, RN, unit manager. Front row, from left, are Kerri Young, RN; Amy Pacholk, RN; Shannon Roman, RN; Maureen Turner, RT, director; and Dawn Teer, RT.
“Were continuing to maintain a zero rate since January, with the use of the kits and ongoing diligence, making sure the line is labeled and dated, and asking daily about the need for the line,” said Abigail Kristt, RN, BC, MS, nurse manager of the ICU at Beth Israel Brooklyn.
Clinicians conduct a root-cause analysis for every CLABSI that occurs. Nursing keeps track of days since an infection and compares Beth Israels results to other similarly sized hospitals.
The infection prevention team awards nurses certificates of appreciation for meeting goals.
“Recognition cheered the team on,” said Mary Anne Gallagher, RN, BC, MA, director of patient care services at Continuum Health Partners, the health system that includes Beth Israel.
Stony Brook University Medical Center
Stony Brook has transformed VAPs from an expected consequence of mechanical ventilation to an anomaly, with not one person in its four ICUs experiencing a VAP in more than a year. The NICU has been VAP-free since 2009.
Lisa Sokoloff, RN, BS, CPHQ, project manager of the Continuous Quality Improvement Department at Stony Brook, credits consistent application of the Institute for Healthcare Improvements VAP bundle, including keeping the head of the bed at a 30 degree or greater angle, following weaning and sedation vacation protocols, using chlorhexidine mouth rinse for oral care, and getting patients up and mobile. Nurses complete a daily goal sheet, checking on compliance and asking about the need for a ventilator during rounds. “Its an across-the-spectrum, multidisciplinary effort,” Sokoloff said.
That took some time, an understanding about the reluctance to change established habits and then tearing down those barriers. But the work has paid off, reducing morbidity, mortality, length of stay and patient costs.
Stony Brook reported an 86.6% VAP-rate decrease in its pediatric ICUs, compared to the 2007 baseline, and an 89.8% decrease in its adult ICUs since the 2006 baseline. That equates to nearly $1.7 million in cost savings.
“I cannot overemphasize the great journey its been and how it epitomizes any good process change — everyone working together to hardwire the right care to the right patient and making it very reliable,” Sokoloff said.
Debra Anscombe Wood, RN, is a freelance writer.