New Study Finds Benefits to Increasing Nurse-Physician Collaboration

Healthcare-associated infections (HAIs) decreased when collaboration between nurses and physicians working in critical care increased, according to a new study published in the April issue of Critical Care Nurse (CCN).

In critical care units in which nurses reported a more favorable perception of nurse-physician collaboration, researchers found lower rates of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI).

Researchers for the study, including Christine Boev, performed a secondary analysis of nurse surveys conducted in four specialized intensive care units (ICUs) over a five year period. The resulting article, “Nurse-Physician Collaboration and Hospital-Acquired Infections in Critical Care,” shows the association between nurses’ perception of their working relationships with physicians and the rates of VAPs and CLASBSIs.

“Our findings suggest that raising the quality of collaboration and communication among nurses and physicians has the potential to improve patient safety,” Boev said in a statement. “Efforts to prevent healthcare-associated infections must include interventions to improve nurse-physician collaboration.”

Boev, an assistant professor at the Wegmans School of Nursing, St. John Fisher College, suggested multidisciplinary daily patient rounds and shared simulation training to improve collaboration.

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 CCN article abstract and full-text PDF is available at: http://ccn.aacnjournals.org/.

Study Finds Weekly Emails Can Empower Nurse Leaders to Help Curb Hospital Acquired Infections

Incorporating hospital leaders into weekly email reports empowered nurses to better fight infections at Jackson Memorial Hospital (JMH) in Miami. As a result the hospital was finally able to curb the spread of the highly resistant organism Acinetobacter baumannii, which it had been battling for 20 years with little success, HealthLeaders Media reports. Acinetobacter baumannii can cause a variety of infections, ranging from pneumonia to wound infections.

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.

This information provided a roadmap for how the bacteria moved through the unit and empowered nurses to take action, according to the study. Charge nurses used print outs of the emails to pre-plan patient placement within the unit. The maps and culture results also showed who was spreading the organisms and individuals who did not clean properly were appropriately disciplined.

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.

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.

HHS Plan to Reduce HAIs on Track for Some Categories, Improvements Still Needed

The Health and Human Services’ (HHS) plan to reduce hospital-acquired infections (HAIs) has made progress in numerous areas, but more work is needed to address all of the categories, according to a new RAND Corporation evaluation published in Medical Care.

The HHS National Action Plan to Prevent Healthcare-Associated Infections focuses on six high-priority HAI categories: clostridium difficile infection; surgical site infection; central line-associated bloodstream infection; ventilator-associated events; catheter-associated urinary tract infection; and methicillin-resistant staphylococcus aureus.

RAND researchers interviewed with representatives from nine HHS regions and found that providers are on track to meet reduction targets for some, but not all HAI categories, FierceHealthcare reports. One area for improvement is ensuring adequate financial resources and staff for HAI prevention, which could be done through collaboration at the federal, regional, and state levels, according to the report. Through collaboration, alliances can leverage financial resources and staff capabilities to focus on larger initiatives, such as patient safety.

Reducing 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.

Can a Necktie Make You Sick?

New legislation introduced in New York state would create an hygienic dress code for medical professionals in an attempt to reduce infections and thereby cut health care costs.

Syracuse's Post-Standard Editorial Board is encouraging of these efforts, but believes that to be truly successful at reducing facility acquired infections, a culture change is in order.  In their editorial, the board recommends that in addition to following a dress code, medical professionals should use checklists, commit to repeated hand-washing and consistently use gloves.

Click here to learn more.

Comment below to share your thoughts - can a necktie make you sick?

Pennsylvania Report Highlights Patient Safety Program, Reduction in Infections

The Pennsylvania Patient Safety Authority has issued its 2010 Annual Report highlighting its Patient Safety Liaison program, educational activities and an announcement about reductions in healthcare-associated infections in hospitals and nursing homes.

"Specifically, catheter-associated urinary tract infections decreased by twenty-six percent, central-line associated bloodstream infections by forty-four percent and ventilator-associated pneumonia by twenty-seven percent," Dr. Stanton Smullens, acting chair of the Pennsylvania Patient Safety Authority, said

Click here for more information.

New Study Shows Inconsistent Reporting Methods Related to HAIs for Pediatric Patients

A significant cause of in-hospital deaths, bloodstream infections are the most common hospital-acquired infection in pediatric intensive care units.  These infections lead to additional medical costs and added length of stay.  It is very troubling that a new study has found substantial inconsistencies in the methods used to report the number of pediatric patients who develop catheter-associated bloodstream infections.  Conducted by the National Association of Children's Hospitals and Related Institutions Pediatric Intensive Care Unit Focus Group, the study appears in the new issue of the American Journal of Infection Control.

Click here to learn more about the study.

Click here to learn more about how INQRI researchers are working to reduce bloodstream infections.

The Kimberly-Clark Corporation has developed a program to raise awareness about healthcare-aquired infections.  Click here to learn more.

Lessons Learned from 9 States on Building Successful HAI Reporting Programs

According to the Centers for Disease Control and Prevention, healthcare-associated infections (HAIs) account for 99,000 deaths per year. In an effort to curb the spread of HAIs, 27 states now require health care facilities to publicly report infection rates.

As state and federal policy-makers consider the merits and feasibility of this reporting, a new report from the National Conference of State Legislatures offers an in-depth look at the challenges of setting up meaningful reporting systems as well as successes and lessons learned from implementation.  The report, which was sponsored by Extending the Cure, a project of the Robert Wood Johnson Foundation’s Pioneer Portfolio, includes insights gained from interviews with state legislators, health care providers and other stakeholders in nine states: Alabama, Colorado, Delaware, Illinois, Massachusetts, New Hampshire, Oregon, Pennsylvania and Washington.

Learn more.
 
The INQRI program is deeply committed to this type of work.  A team of INQRI researchers at Johns Hopkins University has conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. There are some 80,000 catheter-induced bloodstream infections each year, causing up to 28,000 deaths. This study, conducted in ICUs in 12 states, has shown in preliminary analysis that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts. Their study builds on the well-known work of Dr. Peter Pronovost, creator of the line insertion “checklist.” Hospitals that followed the components of their ICU safety program, as well as adopted a safety improvement environment that fostered nurse involvement in quality improvement efforts, reduced, and in some cases completely eliminated, bloodstream infections for several months at a time. Their research is also showing that higher nurse turnover is related to higher infection rates.

The Health and Human Services Department Cites a Need for Improvement on HAIs

According to a report released last week, U.S. hospitals have offered "very little progress" in eliminating hospital-acquired infections (HAIs). The Health and Human Services department's 2009 quality report encourages "urgent attention" be paid to keeping patients safer.

Click here to learn more.

Recent blog entries on this topic:

• How Teamwork Can Reduce the Risk of Infection
• Safe Patients, Smart Hospitals
• What's Enough in Error Reporting?
• "There's Absolutely Nothing as Painful as a Pressure Ulcer"

They All Agree...

...from Pronovost, to Gawande, to INQRI's own grantee team at Johns Hopkins, they all agree - handwashing is vitally important to fighting hospital-acquired infections.

Click here to learn how Abington Memorial Hospital in Pennsylvania addressed the problem head on, increasing their handwashing compliance from 31% in December, 2007 to 88% in September, 2009.

Safe Patients, Smart Hospitals

In Peter Pronovost's new book, Safe Patients, Smart Hospitals, he discusses a "toxic" hospital culture, in which nurses and patients don't feel that they can confront supposedly infallible doctors when they think something is going wrong.

He believes that "hospitals can't improve if they don't acknowledge their errors and try to learn from them."

Dr. Pronovost has commented on the inspiration he has drawn from working with Sorrel King and hearing the story of her 18-month old daughter, Josie, who died as a result of a hospital-acquired, central line infection.  Her story, he has said, inspired him to try to improve hospitals.  He developed a program to prevent central line infections which saved 1,500 lives and $75 million in Michigan over 18 months.  With support from the Agency for Healthcare Research and Quality, Dr. Pronovost and his team are now working with hospitals in each state to implement this program.

Members of Dr. Pronovost's team, David Thompson, Jill Marsteller and Bryan Sexton recently completed an INQRI grant, showing promising results from the first randomized controlled trial to reduce central-line-associated blood stream infections among ICU patients.  Click here to read more about their INQRI project.

Like Dr. Pronovost, INQRI leaders are also inspired by Sorrel and Josie King.  We were very honored when Sorrel presented a webinar for us last month.  Click here to download her slides or view the presentation from your desktop.

Sepsis and Pneumonia Caused by HAIs Killed 48,000 Patients; Cost $8.1 Billion

Two common conditions caused by hospital-acquired infections (HAIs) killed 48,000 people and ramped up health care costs by $8.1 billion in 2006 alone, according to a new study in the Archives of Internal Medicine by researchers at Extending the Cure, a project of Resources for the Future supported by the Robert Wood Johnson Foundation’s Pioneer Portfolio.

Read about the study.