Friday, February 21, 2014

Interdisciplinary Team Approach Needed to Battle HAIs Effectively

Nurse-led, interdisciplinary team-based approaches are needed to effectively prevent hospital-acquired infections (HAIs), according to a new study led by former INQRI grantee Patricia Stone. Neither nurses alone, nor the presence of infection-prevention policies, are enough to keep HAI rates down, HealthLeaders Media reports.

The study was published by Columbia School of Nursing, where Stone is Centennial Professor of Health Policy, and is featured in the American Journal of Infection Control. Among the findings:
  • Central line-associated bloodstream infections (CLABSI): 92 percent of ICUs had a policy for an insertion checklist, but only 52 percent of the health care professionals were seen to adhere to that policy;
  • Ventilator-associated pneumonia: 74 percent of ICUs had a ventilator bundle checklist, but only 52 percent of those treating patients adhered to it; and
  • Catheter-associated urinary tract infection: 27 percent of ICUs had a policy for a nurse-assisted catheter insertion, but only 22 percent were seen to observe that practice.
"Some of these things are really [linked to] nursing," Stone tells HealthLeaders. “But just because HAIs are a nursing-sensitive outcome, doesn't mean that nurses alone bear the responsibility for them. It takes a team, it takes top leadership, it takes everyone on the same page. It's not just a nursing problem."

However, nurse leaders can and should take the lead on making sure that an interdisciplinary team is adhering to infection prevention policies, and establishing such policies when needed. This can include ensuring that nurses have carts for central line insertion and resources like portable bladder ultrasounds. Strong policies, interdisciplinary checks and balances, and leadership are all needed to battle HAIs, according to the study.

Reducing CLABIs was the focus of an INQRI-funded study led by David Thompson and Jill Marsteller. Their study, involving 45 intensive care units in 35 hospitals in 12 states, tested a nurse-led intervention that used a bundle of evidence-based practices to reduce infections. The intervention was successful in significantly reducing infections and also highlighted the importance of promoting a culture of safety and communication. It also established that nurses should play a central role in quality improvement interventions.

Patricia Stone’s INQRI-funded project: “The Impacts of Nurse Staffing, Skill Mix, and Experience on Quality and Costs in Long-Term Care” examined whether there is a causal relationship between nursing input and patient outcomes in long-term care (LTC) facilities.

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