After learning about the above-average hospital-acquired infection (HAI) rates, SUNY Upstate University Hospital in Syracuse, NY, kick-started a fast-paced improvement program to reduce central line infections in all ICUs throughout the facility. A year later, the hospital has reduced its rate to zero, says David Duggan, MD, medical director and quality officer at University Hospital.
"We have tried to look for solutions that make it easy for people to do the right thing, and I think that's the key," Duggan says.
Duggan explains that although infection prevention improvements have helped lower the HAI rate in the med-surge ICU, one of the primary reasons this particular six-bed unit was so high was because it was part burn unit and part general ICU.
"Burn units, when they are standalone units, are actually excluded from this measure because infections are so common in patients with burns," Duggan says. "This unit was included because it did not have the majority of patients with severe burns, but still there was a component of the population there that was extraordinarily susceptible to infections."
Shelley Gilroy, MD, the hospital epidemiologist at University, explains that burn patients can easily become infected with an indigenous flora.
"That's why they are considered a high-risk group and why we might have had an increase in the rate," she says.
The unit was included on the report because it was technically a general ICU, but the numbers didn't account for these susceptible burn patients, Duggan says. Still, a published infection rate that was more than three times the state average elicited a primary focus on infection control.
Implementing the bundle
At the beginning of the year, University formed a multidisciplinary group made of roughly 12 people with the task of implementing the Institute for Healthcare Improvement's (IHI) central line bundle. The group developed forms and documentation that included a checklist, one of the major parts of the bundle.
The group also implemented procedure carts for maximum barrier precautions so that all the required equipment was present at the bedside at the time of the procedure.
Duggan says a very important reason the hospital was able to reduce infection so quickly was because they joined the University HealthSystem Consortium, a membership organization of 103 academic medical centers and 219 affiliated hospitals created to improve the clinical, operational, and financial performance of healthcare facilities.
University joined a group sponsored by the Consortium, which dictated the time frame to implement change, Duggan says. The hospital organized weekly conference calls with the group that assisted University in educating staff members about the bundle and instituting revamped IC policies quickly and effectively.
"They said if you want to join this group get ready to run," Duggan says. "So we put on our track shoes and ran with them and really implemented change in a very short period for a large institution."
Continuing improvement
Although implementing the IHI bundle and improving staff education helped dramatically reduce infections, the quality team at University Hospital has taken additional steps to make IC compliance even simpler.
The hospital recently integrated an electronic data-mining system that pulls in IC information from the laboratory, the pharmacy, and the units so IPs can easily sift through pertinent data.
The hospital has also invested $250,000 to purchase ultrasound technology to use with central line insertion. This device makes it much easier for the physician to correctly insert the line. Duggan says the hospital wanted to implement this technology with the bundle, but the cost delayed the process so it elected to implement the bundle first, and incorporate the ultrasound later.
"We didn't want to delay the IHI bundle so we implemented that, and now we are going to retrain everyone in the hospital on how to place central lines with ultrasound guidance," Duggan says.