When the medical director of infection control began sending weekly emails about infection rates to hospital executives and nurse leaders, things changed. According to a study published in the American Journal of Infection Control, for about a year the director sent weekly emails to the hospital leadership that were copied to staff. The emails:
- Described and interpreted the findings of the preceding week's bundle of interventions;
- Relayed the number and location of new carbapenem-resistant A. baumannii acquisitions;
- Described environmental findings, including culture results and ultraviolet markers (as indicators of cleaning); and
- Included maps of the units showing the location of patients and objects that had tested positive to the organism and weekly action plans.
Including the C-suite in this effort made everyone more accountable, and sharing the infection information helped everyone feel like they were making a difference, Elizabeth Davidson, nurse manager of the surgical intensive care unit at JMH told HealthLeaders Media. Having the weekly emails and directives from the hospital leadership empowered nurses on the unit speak up if they saw someone breaking protocol, such as failing to wash their hands or not cleaning patient rooms properly.
"The nurses became very, very territorial about their patients," Davidson said. "They would really have zero tolerance for a physician, perhaps, that would violate any kind of infection-control practice. They also got much pickier about their rooms being cleaned."
As a result, infections rates began to drop, according to the study, and as of December 2013, the number of new acquisitions of carbapenem-resistant A. baumannii was down to one per month hospital-wide, even after the weekly emails stopped.
Utilizing a nurse-led intervention to reduce central line-associated bloodstream infections 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.