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/.
Showing posts with label Jill Marsteller. Show all posts
Showing posts with label Jill Marsteller. Show all posts
Thursday, April 2, 2015
Thursday, March 19, 2015
Nurse Team Reduces CAUTI Infections Through EHR Tool
A nurse-led initiative at a Missouri hospital used Electronic Health Records (EHRs) to reduce the number of catheter-associated urinary tract infections (CAUTIs) by 25 percent in its facilities, Becker’s Health IT & CIO Review reports.
Eileen Phillips, an RN at the University of Missouri Health System, led a team of nurses in reviewing literature on infections. The team then developed a list of appropriate, evidence-based indications for catheter use, and included a step in their EHRs that required nurses to document the reasons for use of a catheter. This led to a decrease in use of catheters and contributed to the subsequent 25 percent drop in infections.
The nursing team also began an educational and communications campaign called “CAUTIon: Zero Infections Ahead” that used web-based modules, posters, rewards systems, weekly quizzes, and staff meetings to highlight best practices for catheter use.
"This could not have occurred without first reducing our utilization, which is why the EHR task has helped so much," Phillips said in a blog post Q&A on Cerner’s website. "In 2013, our catheter utilization was 33 percent, and in 2014, utilization decreased to 25 percent, which is a 24 percent overall decrease. I am really happy with the progress we have made so far."
Reducing central line 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.
Eileen Phillips, an RN at the University of Missouri Health System, led a team of nurses in reviewing literature on infections. The team then developed a list of appropriate, evidence-based indications for catheter use, and included a step in their EHRs that required nurses to document the reasons for use of a catheter. This led to a decrease in use of catheters and contributed to the subsequent 25 percent drop in infections.
The nursing team also began an educational and communications campaign called “CAUTIon: Zero Infections Ahead” that used web-based modules, posters, rewards systems, weekly quizzes, and staff meetings to highlight best practices for catheter use.
"This could not have occurred without first reducing our utilization, which is why the EHR task has helped so much," Phillips said in a blog post Q&A on Cerner’s website. "In 2013, our catheter utilization was 33 percent, and in 2014, utilization decreased to 25 percent, which is a 24 percent overall decrease. I am really happy with the progress we have made so far."
Reducing central line 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.
Friday, January 9, 2015
Preventing Hospital Acquired Infections among Elderly ICU Patients Reduces Death Risk, Saves Money
Elderly patients who develop hospital-acquired infections (HAIs) while in intensive care units (ICU) are approximately 35 percent more likely to die within five years than other patients, according to a new study co-authored by INQRI grantee Patricia Stone.
The most common HAIs are bloodstream infections caused by central lines and pneumonia caused by ventilators, reports Advanced Healthcare Network for Nurses. Decreasing the incidents of these two HAIs alone could increase the odds that ICU patients survive, and reduce health care costs by more than $150,000, according to Stone’s study.
Stone and her colleagues examined outcomes for 17,537 Medicare patients over a five year period and found that while 57 percent of all the elderly ICU patients had died, nearly 80 percent of patients who developed HAIs during their ICU stays died.
"Any death from preventable infections is one too many," Stone tells Advanced. "We've known for decades what works to prevent infections and save lives. Now, our study shows just how much money can be saved by investing in prevention."
The paper, "A decade of investment in infection prevention: A cost-effectiveness analysis," was published in the January 2015 issue of the American Journal of Infection Control and was funded by the National Institute of Nursing Research.
Reducing central line 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.
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.
The full Advanced article is available here.
The most common HAIs are bloodstream infections caused by central lines and pneumonia caused by ventilators, reports Advanced Healthcare Network for Nurses. Decreasing the incidents of these two HAIs alone could increase the odds that ICU patients survive, and reduce health care costs by more than $150,000, according to Stone’s study.
Stone and her colleagues examined outcomes for 17,537 Medicare patients over a five year period and found that while 57 percent of all the elderly ICU patients had died, nearly 80 percent of patients who developed HAIs during their ICU stays died.
"Any death from preventable infections is one too many," Stone tells Advanced. "We've known for decades what works to prevent infections and save lives. Now, our study shows just how much money can be saved by investing in prevention."
The paper, "A decade of investment in infection prevention: A cost-effectiveness analysis," was published in the January 2015 issue of the American Journal of Infection Control and was funded by the National Institute of Nursing Research.
Reducing central line 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.
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.
The full Advanced article is available here.
Friday, July 25, 2014
New Guidance Shows Importance of Evidenced-Based Best Practices in Hygiene
A new guidance published in the August issue
of Infection Control and Hospital Epidemiology emphasizes the importance of
proper hand hygiene to prevent the spread of health care-associated infections,
reports Health Canal. RWJF Health & Society Scholars
program alumna Allison Aiello
and her colleagues developed the guidance, which includes a series of evidenced-based best practices for optimal hand hygiene in health care settings. The guidance encourages
increased availability and acceptability of certain soap and alcohol-based
rubs and the development of a system to empower health care personnel to create a
personalized hygiene system that gives them a way to track their progress.
The recommendations include developing a multidisciplinary
team in which representatives from administrative and unit-level leadership
work together to establish a hand hygiene program that best fits each
institution. The program should include clear performance targets and an action
plan for improving adherence, according to the guidelines.
An INQRI-funded study published last year in Critical
Care Medicine found that a nurse-led intervention combining a “bundle” of
evidence-based practices with a comprehensive safety program dramatically
reduced the mean rate of health care-associated infections. The study was
conducted by David Thompson and Jill Marsteller associate professors at Johns Hopkins University in the School
of Medicine and Bloomberg School of Public Health, respectively, and by J.
Bryan Sexton now at the Duke University Health System Patient Safety Center.
Monday, May 19, 2014
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:
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.
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.
Thursday, May 8, 2014
Rates of Infections, Falls, Pressure Ulcers, Other Hospital Acquired Conditions Drop
Hospitals saw a nine percent decrease in harms experienced by patients from 2010 to 2012, according to a new report from the U.S. Health and Human Services Department (HHS). There were reductions in adverse drug events, falls, infections, pressure ulcers, and other areas, estimated to have prevented nearly 15,000 deaths and 560,000 cases of patients being harmed in hospitals.
The HHS report also shows that the incidences of hospital-acquired infections dropped from 145 per 1,000 discharges in 2010 to 132 per 1,000 discharges in 2012, resulting in 560,000 few incidents in two years, FierceHealthcare reports. Falls and trauma declined 14.7 percent and pressure ulcers fell 25.2 percent.
In addition to lives saved, the reduction in harm to patients saved $4.1 billion according to the report, which credits factors such as diverse public-private partnerships, active engagement by patients and families, and new tools provided by the Affordable Care Act (ACA), with the improvement. In 2011, under the ACA, HHS launched the Partnership for Patients, a nationwide public private initiative to keep patients from being harmed in hospitals and heal without complication. The Partnership shares best practices with more than 3,700 hospitals enrolled in the initiative.
INQRI grantees have conducted a number of studies into how nurses can lead efforts to reduce medical errors and patient harm, including:
The HHS report also shows that the incidences of hospital-acquired infections dropped from 145 per 1,000 discharges in 2010 to 132 per 1,000 discharges in 2012, resulting in 560,000 few incidents in two years, FierceHealthcare reports. Falls and trauma declined 14.7 percent and pressure ulcers fell 25.2 percent.
In addition to lives saved, the reduction in harm to patients saved $4.1 billion according to the report, which credits factors such as diverse public-private partnerships, active engagement by patients and families, and new tools provided by the Affordable Care Act (ACA), with the improvement. In 2011, under the ACA, HHS launched the Partnership for Patients, a nationwide public private initiative to keep patients from being harmed in hospitals and heal without complication. The Partnership shares best practices with more than 3,700 hospitals enrolled in the initiative.
INQRI grantees have conducted a number of studies into how nurses can lead efforts to reduce medical errors and patient harm, including:
- 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.
- The INQRI funded project “Interdisciplinary Mobility Team Approach to Reduction of Facility-Acquired Pressure Ulcers” developed a sustainable, system-wide program for pressure ulcer prevention that enhances mobility of long-term care (LTC) residents. The primary goal, under nursing's leadership, was to reduce LTC facility-acquired pressure ulcer incidence by 50 percent using a cost-effective innovative program to increase resident active or passive movement. The team, which developed and implemented a program that involved using musical cues to remind residents to move or staff to help residents move, was led by Tracey Yap, a nurse researcher, and Jay Kim, an engineer.
- INQRI grantee Patti Dykes worked with a team to develop the Falls: Tailoring Interventions for Patient Safety (Falls TIPS) online tool kit to educate patients and families about how they can work with nurses and other providers to prevent falls. The toolkit was developed based on the Fall TIP: Validation of Icons to Communicate Fall Risk Status and Tailored Interventions to Prevent Patient Falls study, which involved developing and validating a set of icons designed to communicate fall risk status, and developing tailored interventions to prevent patient falls in hospitals.
Thursday, April 24, 2014
Nurses Can Effectively Use Hospital Approach to Infection Prevention in Dialysis Settings
Safety assessment tools and interventional approaches, such as those used by nurses in hospitals, are also effective in reducing catheter-related blood stream infections (CRBSIs) in outpatient dialysis settings, Nephrology News & Issues reports.
The study, A Pilot Quality Improvement Program to Minimize Catheter-Related Bloodstream Infection in an Outpatient Hemodialysis Setting, was presented at the 45th annual meeting of the American Nephrology Nurses Association. Research was led by Nancy Culkin of DaVita HealthCare Partners, a specialty contract research organization focusing on drug and device development.
The study concludes that approaches which have successfully reduced CRBSIs in hospitals can be applied in chronic dialysis facilities, including procedural kits with materials such as: a checklist, antimicrobial swabs for skin prep, triple antibiotic ointment for onsite application, alcohol swabs to facilitate hub scrub, and exit site dressing.
An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of central line-associated bloodstream infections. The study was conducted by David Thompson and Jill Marsteller, associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton, now at the Duke University Health System Patient Safety Center.
“It’s important to note that this was a nurse-led intervention,” Marsteller said. “The units’ success in reducing infections not only demonstrates the effectiveness of the intervention, but also confirms that nurses can have and should play a central role in quality improvement interventions.”
The study, A Pilot Quality Improvement Program to Minimize Catheter-Related Bloodstream Infection in an Outpatient Hemodialysis Setting, was presented at the 45th annual meeting of the American Nephrology Nurses Association. Research was led by Nancy Culkin of DaVita HealthCare Partners, a specialty contract research organization focusing on drug and device development.
The study concludes that approaches which have successfully reduced CRBSIs in hospitals can be applied in chronic dialysis facilities, including procedural kits with materials such as: a checklist, antimicrobial swabs for skin prep, triple antibiotic ointment for onsite application, alcohol swabs to facilitate hub scrub, and exit site dressing.
An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of central line-associated bloodstream infections. The study was conducted by David Thompson and Jill Marsteller, associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton, now at the Duke University Health System Patient Safety Center.
“It’s important to note that this was a nurse-led intervention,” Marsteller said. “The units’ success in reducing infections not only demonstrates the effectiveness of the intervention, but also confirms that nurses can have and should play a central role in quality improvement interventions.”
Monday, April 7, 2014
Infections Drop by nearly 20 Percent with Reduced Blood Transfusions
Reducing the amount of red blood cell (RBC) transfusions performed in hospitals can also reduce infection rates, according to a new study published in the Journal of the American Medical Association.
Researchers from the University of Michigan and the University of Rochester School of Medicine and Dentistry studied 18 clinical trials, comparing those which restricted use of blood transfusions with a more liberal transfusion strategy. They found that incidence of health care-associated infections was 11.8 percent in the restrictive group and 16.9 percent in the liberal group.
The study shows that RBCs can be a more costly and dangerous treatment method than previously believed, according to the researchers.
"Many people are beginning to accept that we can make a difference--despite being taught in medical school that blood transfusions 'might help and can't hurt,'" Neil Blumberg, professor at the University of Rochester School of Medicine and Dentistry tells HealthCanal. "What we've found is actually the opposite, that it can hurt and it rarely helps."
An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of infections. The study was conducted by David Thompson and Jill Marsteller associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton now at the Duke University Health System Patient Safety Center.
Researchers from the University of Michigan and the University of Rochester School of Medicine and Dentistry studied 18 clinical trials, comparing those which restricted use of blood transfusions with a more liberal transfusion strategy. They found that incidence of health care-associated infections was 11.8 percent in the restrictive group and 16.9 percent in the liberal group.
The study shows that RBCs can be a more costly and dangerous treatment method than previously believed, according to the researchers.
"Many people are beginning to accept that we can make a difference--despite being taught in medical school that blood transfusions 'might help and can't hurt,'" Neil Blumberg, professor at the University of Rochester School of Medicine and Dentistry tells HealthCanal. "What we've found is actually the opposite, that it can hurt and it rarely helps."
An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of infections. The study was conducted by David Thompson and Jill Marsteller associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton now at the Duke University Health System Patient Safety Center.
Wednesday, March 26, 2014
More than a Third of Patients at Community Hospitals Receive Inappropriate BSI Antibiotics
One out of every three community hospital patients being treated for a bloodstream infection (BSI) get inappropriate antibiotic therapy, according to a new study published in PLoS One and reported on by FierceHealthcare. The research was led by Deverick J. Anderson, MD, a Robert Wood Johnson Foundation Physician Faculty Scholars alumnus.
Researchers conducted the study on nearly 1,500 adult patients with BSIs at nine community non-academic hospitals in North Carolina and Virginia from 2003 to 2006. Hospital staff gave more than one in three (38 percent) of the patients studied inappropriate antibiotics, according to researchers. Most of the infections analyzed in the study were health care associated, according to the study abstract.
MedPage Today, Infection Control Today and HealthDay News also reported on Anderson’s findings.
An INQRI-funded study found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of bloodstream infections. The study was conducted by David Thompson, DSNc, MSN, RN, and Jill Marsteller PhD, MPP, associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton, PhD, now at the Duke University Health System Patient Safety Center.
Researchers conducted the study on nearly 1,500 adult patients with BSIs at nine community non-academic hospitals in North Carolina and Virginia from 2003 to 2006. Hospital staff gave more than one in three (38 percent) of the patients studied inappropriate antibiotics, according to researchers. Most of the infections analyzed in the study were health care associated, according to the study abstract.
MedPage Today, Infection Control Today and HealthDay News also reported on Anderson’s findings.
An INQRI-funded study found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of bloodstream infections. The study was conducted by David Thompson, DSNc, MSN, RN, and Jill Marsteller PhD, MPP, associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton, PhD, now at the Duke University Health System Patient Safety Center.
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:
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.
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.
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.
Tuesday, February 4, 2014
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.
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.
Thursday, December 5, 2013
Joint Commission Guidelines for Preventing Bloodstream Infections Emphasize Role of Nurses
Guidelines and a toolkit released this week by the Joint Commission highlight the key role nurses play in preventing central line-associated bloodstream infections (CLABSIs). CLABSIs are among the most deadly and costly hospital-associated infections, accounting for 31,000 deaths annually and costing the health system an estimated $9 billion. Studies funded by INQRI revealed that nurses can play a key role in preventing these infections.
Patricia Stone, PhD, MPH, RN, FAAN, a principal investigator for an INQRI-funded study on the impact of nurse staffing, skill mix, and experience on quality and costs in long-term care, contributed to the new guidelines. Stone is the Centennial Professor of Health Policy in Nursing at Columbia University School of Nursing.
An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of infections. The study was conducted by David Thompson, DSNc, MSN, RN, and Jill Marsteller PhD, MPP, associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton, PhD, now at the Duke University Health System Patient Safety Center.
“It’s important to note that this was a nurse-led intervention,” Marsteller said. “The units’ success in reducing infections not only demonstrates the effectiveness of the intervention, but also confirms that nurses can have and should play a central role in quality improvement interventions.”
Patricia Stone, PhD, MPH, RN, FAAN, a principal investigator for an INQRI-funded study on the impact of nurse staffing, skill mix, and experience on quality and costs in long-term care, contributed to the new guidelines. Stone is the Centennial Professor of Health Policy in Nursing at Columbia University School of Nursing.
An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of infections. The study was conducted by David Thompson, DSNc, MSN, RN, and Jill Marsteller PhD, MPP, associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton, PhD, now at the Duke University Health System Patient Safety Center.
“It’s important to note that this was a nurse-led intervention,” Marsteller said. “The units’ success in reducing infections not only demonstrates the effectiveness of the intervention, but also confirms that nurses can have and should play a central role in quality improvement interventions.”
Wednesday, October 23, 2013
International Infection Prevention Week 2013
October 20-26 is International Infection Prevention Week (IIPW), sponsored by the Association for Professionals in Infection Control and Epidemiology (APIC). APIC leads this annual effort to highlight the importance of infection prevention to improve patient outcomes.
In honor of IIPW 2013, APIC is launching the Infection Prevention and You campaign with free online resources to encourage health professionals to spread the word about the dangers of lack of infection prevention in healthcare settings. In addition, research studies on infection prevention are available in APIC’s American Journal of Infection Control. The October 2013 Journal features a study on the quality of publicly reported central line-associated bloodstream infection data in Colorado.
Previous studies in Colorado found significant under-reporting of central line-associated bloodstream infections, which led the Colorado Department of Public Health and Environment to perform onsite validation visits to assess surveillance practices and retrospective chart reviews of patients in ICUs with positive blood cultures during the first quarter of 2010. They found wide variation in surveillance practices and in application of definition criteria. The study revealed that infections were under-reported by 33 percent and the authors concluded that the Department of Public Health and Environment should validate self-reported healthcare-associated infection data.
An INQRI study out of Johns Hopkins University was the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. The study was conducted in ICUs in 12 states and nurses led the infection control efforts. Measured 19 months after implementation, infection rates were reduced by 81 percent. The project findings are presented in a research brief on RWJF's website. David Thompson and Jill Marsteller led the research.
In honor of IIPW 2013, APIC is launching the Infection Prevention and You campaign with free online resources to encourage health professionals to spread the word about the dangers of lack of infection prevention in healthcare settings. In addition, research studies on infection prevention are available in APIC’s American Journal of Infection Control. The October 2013 Journal features a study on the quality of publicly reported central line-associated bloodstream infection data in Colorado.
Previous studies in Colorado found significant under-reporting of central line-associated bloodstream infections, which led the Colorado Department of Public Health and Environment to perform onsite validation visits to assess surveillance practices and retrospective chart reviews of patients in ICUs with positive blood cultures during the first quarter of 2010. They found wide variation in surveillance practices and in application of definition criteria. The study revealed that infections were under-reported by 33 percent and the authors concluded that the Department of Public Health and Environment should validate self-reported healthcare-associated infection data.
An INQRI study out of Johns Hopkins University was the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. The study was conducted in ICUs in 12 states and nurses led the infection control efforts. Measured 19 months after implementation, infection rates were reduced by 81 percent. The project findings are presented in a research brief on RWJF's website. David Thompson and Jill Marsteller led the research.
Friday, May 24, 2013
New Sepsis Guidelines Put Nurses at the Center
Hospital-acquired infections can be deadly and nurses can play a key role in preventing or ameliorating those infections. New guidelines for helping hospital patients survive sepsis, through early recognition and timely interventions recognize and capitalize on nurses' interaction with and proximity to patients. The guidelines, published in Critical Care Medicine and Intensive Medicine, highlight the role of critical care nurses in identifying patients with sepsis, initiating treatment and collecting data. That role was the focus of a presentation at the American Association of Critical-Care Nurses 2013 National Teaching Institute and Critical Care Exposition in Boston earlier this month, covered in MedScape Medical News.
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.
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.
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