Infection Control on a Shoestring Budget

What do Contra Costa Regional Medical Center and '80s action hero MacGyver have in common?

Both used duct tape to save lives.

Duct tape and Ziploc bags were two main ingredients in a culture shift that's helped the Martinez, CA–based medical center reduce cases of ventilator-associated pneumonia (VAP) and central line–associated bloodstream infections (CLABSIs) to nearly zero.

To help reduce VAP, the team placed red duct tape on the walls of patient rooms to remind staff to elevate the head of the patient's bed by 30 degrees, which has been shown to reduce the risk of VAP. Ferris says the red line on the wall provides a visual cue for people (including the housekeeping staff and patient families) to know that the top of the mattress should be even with the duct tape.

"We're a county hospital and duct tape doesn't cost a whole lot," she adds.

On the CLABSI front, Ferris says she interviewed staff and discovered that nurses were spending a lot of time gathering equipment. So she went to the store and bought jumbo-sized Ziploc bags and created kits that included supplies like a full drape, surgical gown, cap, mask, and a compliance checklist.

Nurse leaders need to maintain enthusiasm and make it easy for staff nurses to follow the protocol. In addition, everyone with a stake in infection outcomes—including nurse leaders, staff nurses, and physicians—should have be able to make suggestions for improvement.

Ferris also emphasizes paying attention to, and learning from, successes and failures. "You have to acknowledge what goes wrong, and you have to celebrate what goes right," she says.

For example, when a VAP occurs, her team meets immediately to discuss what happened. But when they find positive outcomes, they throw pizza parties.

Ferris has spent more than two decades in infection control. During most of that time, she says, sheacted more as an "infection accountant," counting the number of infections that occur. But since implementing these small changes with nurses, her role has changed.

"I got to become a preventionist," she says. "And that's far more exciting."

Duct tape and Ziploc bags aren't the only things Contra Costa Regional Medical Center introduced to reduce infections.

Here's a list of all its strategies.

For VAP:

• Adopting an oral hygiene kit and protocol, for which the night shift nurse hangs 24 hours' worth of oral hygiene supplies on the wall in patients' rooms to remind staff to frequently clean and disinfect patients' mouths
• Implementing the "wake up and breathe" protocol, which directs nurses to automatically turn off all sedation medications at 6 am, unless there is a contraindication
• Placing red duct tape on the walls of patient rooms to remind staff to elevate the head of the patient's bed by 30 degrees
• Using elements of the Institute for Healthcare Improvement's (IHI) ventilator bundle, which includes a series of interventions for ventilator care, in nursing flow sheets and physician orders

For CLABSI:

• Drawing on elements of IHI's central line bundle to develop kits that incorporate elements such as reminder and monitoring forms and appropriate clothing, including full drape, surgical gown, cap, mask, and a compliance checklist