Tuesday, July 14, 2015

CLASBIs Rates Improved When Hospitals Implement Airline Industry Approach

Hospitals around the country are reducing central line associated bacterial infections (CLASBIs) by taking a “plane crash” instead of a “car crash” approach in their efforts, according to a VOX special report.

The theory is that car companies see accidents as unavoidable, no matter how much work goes into prevention. The aviation industry, however, treats each crash as potentially preventable and investigates how it could have been prevented. A similar divide exists among hospitals when it comes to treating CLASBIs central line infections, Vox reports.

While some hospitals view the infections as bad but inevitable, other hospitals “see each central line infection as a failure that requires investigation and better preventive techniques in the future.” And many of these “plane crash” hospitals are reducing infections, in part by empowering nurses and giving them the tools to prevent infections.

Peter Pronovost, a critical care physician at Johns Hopkins University in Baltimore, created a simple five-item checklist that centers on cleanliness when inserting central lines, and changing the dressing, and implementing changes such as centralized stock carts. But one of the most significant changes the hospital implemented was to instruct nurses to “call out” doctors who were not following checklists. Within three months, CLASBIs decreased by 50 percent, and they decreased by 70 percent after six months.

Hospitals in Michigan and California Follow Suit

After hearing of the success at Johns Hopkins, the Michigan Hospital Association implemented a similar the protocol at about 60 hospitals in the state, and realized a 70 percent decrease within three months. Similarly, Roseville Medical Center in California implemented its own version of Pronovost’s checklist and also gave an 18-nurse vascular access team exclusive responsibility for inserting and monitoring central lines. For seven years after the new program was instituted, Roseville did not have a single central line infection.

When the hospital’s seven year streak broke in 2014, Roseville decided to investigate. The investigation revealed that subcontracted nurses who treated dialysis patients, but who were not part of the central line team, were responsible for the infections. As a result of the findings the hospital now requires annual competency checks for contract nurses who manage central lines.

“The Roseville response mirrors what airlines do at a moment of crisis: analyze the situation and implement new policies that could prevent the same type of problem in the future.”

Reducing CLASBIs 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.

The full VOX article is available here.

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