Evidenced-based best practices can reduce healthcare associated infections

Healthcare associated infections, such as catheter related acute bloodstream infections (CLABSI) and ventilator associated pneumonia (VAP), significantly affect hospital morbidity and mortality but by developing evidenced-based, best practices, these occurrences can be minimized, according to research from surgeons at Thomas Jefferson University Hospital.

The data found on healthcare associated infections will be included as a poster presentation at The 2011 Clinical Congress of the American College of Surgeons — one of the largest international meetings of surgeons in the world — on October 26 in San Francisco. The poster, titled "Focused, Bundled Initiatives Can Substantially Decrease Healthcare-Associated Infections" will be included in the Scientific Exhibits program.

Lead researcher Niels D. Martin, M.D., F.A.C.S., an acute care, trauma and critical care surgeon with the department of Surgery at Thomas Jefferson University Hospital, said the initiatives resulted in improved patient care and a significant healthcare cost savings.

Using bundled initiatives over a five-year period, between 2005 and 2010, Jefferson's CLABSI rate fell from 5.34 per 1,000 device days to 0.41. Similarly, VAP rates decreased from 10.0 per 1,000 ventilator days to 1.12.

"The work really started out as a performance improvement initiative of our infection control sub-committee," says Dr. Martin. "The subcommittee included nurses, physicians, respiratory therapists, administrators, and representatives from various departments throughout the hospital. This multidisciplinary approach allowed for buy-in from all stakeholders involved in caring for critically ill patients at Jefferson.

"The team was split into two, one for CLABSIs and one for VAPs. The respective teams searched medical literature, spoke with experts around the world, and attended conferences presenting the current 'best practices' in medicine."

Dr. Martin says the teams then created care "bundles." These bundles were composed of many of the separate elements each team learned about. The teams then devised strategies to implement all the elements including some new devices, methods of care, and staff education.

Elements of the CLABSI reduction bundle included a daily needs assessment for early removal, an insertion checklist with nurse oversight and a dedicated TPN port that is labeled. For the VAP reduction bundle, examples included a daily sedation vacation, daily readiness to wean assessment (SBT) and compliance documentation on the nursing flow sheet.

"Ultimately, we have significantly improved the care delivered here at Jefferson," adds Dr. Martin. "Our infection rates are significantly lower than even our original goals. Healthcare associated infections are something all hospitals are looking to reduce. It is our hope that Jefferson can serve as a model for other institutions to further prevent CLABSI and VAP infections."

Source: Thomas Jefferson University Hospitals