Using Dynamite to Blow Up Infections
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The Saint Raphael success story had a few false starts. But in picking apart its processes one by one and reexamining everything it did, team members isolated a number of process errors and defects. And improve they did, coming from 3.99 bloodstream infections per 1,000 line days during the first 15 months, between January 2009 and March 2010—one of the state's highest rates—to 0.18 over the past 18 months, between January 2011 and August 2012, one of the state's lowest rates, Kliger says.
To understand Saint Raphael's improvement story, one must look back to 2008 and 2009, when the state of Connecticut launched an HAI reporting program, first by hospital size and then by hospital name.
The infection control department wasn't worried, recalls Diane Dumigan, Saint Raphael's infection preventionist. "We kept saying, 'We are close to the national mean, or we're just a little above, it, or this month we're a little below it.' "
After all, the team had implemented the well-known Institute for Healthcare Improvement "bundle" for infection prevention from 2000 to 2008, such as requiring sterile caps, gowns, gloves, and masks on all inserters, fenestrated patient drapes, chlorhexidine cleaning of skin at the line insertion sites, and using a checklist.
But with the state data out there, "when we started comparing to our colleagues, to our neighbors, we realized we were the outliers. It was an aha moment," she says.
"We were really distressed to see that our infection rate in our ICUs was so high," Kliger says. It was, he acknowledges, embarrassing.
In addition, every additional day an HAI keeps a patient in the hospital increases cost as it delays recovery. These infections were not just hurting patients; they were costing the hospital money.
John Boyce, MD, epidemiologist for the Hospital of Saint Raphael and now the director of hospital epidemiology and infection control for the merged facility, made the patient care decision that the hospital needed to get serious about stopping CLABSIs.
He found studies showing that for each hospital CLABSI, the hospital absorbs an average of $16,550 in excess hospital costs, and if the infection occurs in a patient undergoing hemodialysis, the cost can add an average excess cost as high as $22,240. Very complicated bloodstream infections can be as high as $32,462 as a mean average cost from initial hospitalization, in 2001 dollars, according to studies from the Centers for Disease Control and Prevention.
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