GNYHAUHF Quality Improvement Collaborative: Reducing Central Line Associated Blood Stream Infections

1
GNYHA/UHF Quality Improvement Collaborative
Reducing Central Line Associated Blood Stream
Infections in ICUs

• APIC NYC Presentation
• March 16, 2005

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Central Line Associated Bloodstream Infections
(CLAB)

• Incidence 250,000 CLAB per year
• Prolonged hospitalization
• Mean7 days Haley, Am J Med 1981 70 51-8
• Median22 days Dimick JB. Arch Surg 2001 136
  229-34
• Increased mortality
• Attributable mortality of 2.7 (95CI2.0-3.4)
  Byers, 5th SHEA 1995 abstract 43
• Excess hospital costs per episode
• 6,000 in 1988 Maki, Am J Med 1988 85 307-13
• 40,000 in 1991 Pittet, JAMA 1994 271
  1598-601
• 56,000 in 1998-99 Dimick. Arch Surg 2001
  136 229-34

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Prevention of Healthcare-Associated Infections

• Patient expectation
• JCAHO Patient Safety Goals
• IHI 100K Lives Campaign
• Public reporting of hospital infection rates
• 4 states already have public reporting
  requirements
• Legislation is in progress in many other states,
  including NY
• Public interest groups
• Reduce Infection Deaths (RID), Betsy McCaughy

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Pittsburgh Regional Healthcare Initiative

• Zero tolerance policy
• Make infection prevention everyones business
• From custodian to cardiac surgeon
• The people who do the work have to drive the
  change.
• Standardize practice
• Real-time investigation of the root cause of each
  CLAB as soon as it occurs
• Observe practices
• Make improvements based on observations and RCA

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GNYHA/UHF Project Description

• Implementation of a standard ICU infection
  control care protocol
• Hand hygiene
• Maximal barrier precautions
• Chlorhexidine skin antisepsis
• Appropriate site and administration system care
• No routine replacement of catheters
• Development of an interdisciplinary team led by
  Chair of Medicine/Surgery or ICU Director(s)

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GNYHA/UHF Project Description (2)

• Real-time investigation of root cause of every
  CLAB
• Regular data collection and reports
• Education conference calls, meetings, site
  visits
• Completion of Patient Safety Culture Survey

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GNYHA/UHF Responsibilities

• Plan and implement learning sessions and
  conference calls
• Provide consultation regarding standardization of
  practices
• Web based educational sessions
• Maintain and safeguard confidentiality

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Participant Criteria

• Must be willing and able to implement
  rapid-improvement change
• Provide a physician senior leader and sponsor who
  will actively support the team
• Must make a one year commitment
• Must share data with GNYHA and UHF on a
  bi-weekly basis

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Participant Criteria

• Must disseminate project findings upon completion
• ICU staff must intervene throughout the hospital
  when a central line insertion is not following
  new protocol.

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Project Team Members

• ICU Physician Leader/Intensivists
• ICU Nursing Leader
• Day to Day Manager/key contact
• Environmental Services
• Materials Management
• Infection Control
• ED Department Attending
• Respiratory Therapy
• Pharmacy
• Other e.g Dietary

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Key Points

• Project seeks leadership from Chair of
  Medicine/Surgery or ICU to lead the project
• Leadership is needed from nursing manager(s) of
  the participating ICUs
• Infection Control should be part of, but not the
  leader of, the project team
• Representation from Materials Management and
  Environmental Services
• All team members are expected to participate in
  all learning sessions.

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Project Timeline

• Submit Letter of Interest signed by CEO (early
  February)
• Designate Project leader
• Submit application (March 23)
• Participant selection by GNYHA/UHF
• 15-20 hospitals will be selected
• Address data reporting/confidentiality and IRB
  issues
• Project kick-off in late April 2005

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CLAB Project Leaders

• Greater New York Hospital Association
• Terri Straub Vice President for Quality and
  Patient Safety, GNYHA
• United Hospital Fund
• Rachel Block, Project Director
• Project Advisory Committee