In October, the U.S. Department of Health and Human Services, the Association for Professionals in Infection Control and Epidemiology and the Society for Healthcare Epidemiology of America recognized the Saint Raphael Campus of Yale-New Haven Hospital with the first annual 2012 Partnership in Prevention Award for achieving the greatest sustainable improvements in eliminating healthcare-associated infections (HAIs).
The work that earned the Hospital of Saint Raphael (HSR) its national award began in 2009. With 14 other hospitals in the state, HSR joined a voluntary program sponsored by the Connecticut Hospital Association (CHA). The CHA was working with this group of hospitals to develop ways to improve central line-associated blood stream infection (CLABSI) rates throughout the state.
Through its work with CHA, HSR found that its medical intensive care units had one of the highest CLABSI rates in Connecticut — with 3.99 central lineassociated bloodstream infections per 1,000 central line catheter days.
John M. Boyce, MD, HSR hospital epidemiologist, knew that only an interdisciplinary approach would drive down this rate and developed a team that included hospital administrators, laboratory staff, physicians, nurses and allied healthcare providers to attack the problem head-on.
Over the course of the next year, the team introduced numerous best practices based on effective infection control, clinical microbiology, and evidence-based medical and nursing literature into the ICU. By 2011, the hospital had successfully reduced its CLABSI rate in the ICU down to one of Connecticut's lowest rates with 0.18 infections/1,000 central line catheter days.
Some of the changes that HSR put in place included: development of a standardized line insertion kit; using antibiotic-coated catheters; dramatic reduction of insertion of central lines in the ED; improved line maintenance and removal protocols; and improved training at all levels.
To re-educate the house staff, HSR brought in a mobile simulation laboratory specially equipped with mannequins and equipment that would allow them to practice sterile insertion of central lines. In addition, all nurses who inserted peripheral-inserted central catheters (PICCs) were also re-certified.
"Reducing CLABSIs was a major undertaking that is absolutely crucial for the safety and health of our patients," said Dr. Boyce, who is now director, Epidemiology and Infection Control for YNHH.
"Our support began with the Board of Trustees and permeated the entire organization — the effort was that important," said Alan Kliger, MD, former HSR vice president and chief medical and quality officer, and now chief quality officer, YNHHS. "Everyone understood that we had to drive down our infection rates."
Another area that the team investigated was the relationship between drawing blood from a central line and infection rates. The team researched the rate of contamination when blood cultures are drawn from central lines and began to eliminate this practice.
"The members of our team were creative in their approach to discovering root causes for infection," said Diane Dumigan, RN, infection preventionist, Quality Improvement Support Services, "and staff members were willing to learn new procedures and change their ways once a best practice was discovered.
It took two years to dramatically reduce CLABSIs in our intensive care units, but we have sustained results in all of our ICUs right through 2012." As the director of Epidemiology and Infection Control for Yale-New Haven, Dr. Boyce sees opportunity to introduce the interventions developed on the Saint Raphael Campus to units throughout the combined hospital. Dr. Boyce points out that the SICU on the SRC has gone 39 weeks since its last CLABSI and its CTICU has not had a CLABSI for the past 130 weeks.
"What truly motivates each person in health care is the safety of his or her patient," said Jeannette Bronsord, RN, director, Intensive Care Nursing, SRC. "It is heartening to see how staff work collaboratively to develop and then employ tools that improve the quality of care we give our patients."