Yesterday I described some of what I learned in my time with the Pittsburgh Regional Health Initiative. Today I write about two hospitals’ -- Allegheny General and the Veterans Affairs hospital -- concrete achievements in fighting hospital acquired infections (HAIs). It’s a particularly timely topic, as the health reform bills do begin to address reducing such infection rates, and Sen. Susan Collins -- a Maine Republican moderate who could end up voting for a health reform bill -- is pushing for stronger language.
Attending a Perfecting Patient Care quality improvement course in 2003, Allegheny General’s director of medicine Dr. Richard Shannon found the inspiration and strategy to combat central line-associated bloodstream infections. Dr. Shannon encouraged clinicians working in the two intensive care units under his supervision to apply the perfecting care principles and standardize central line IV procedures. Hospital workers started using standardized kits for each central line procedure. By making the process more consistent, they also made it safer and more efficient.
I was fortunate to see Dr. Shannon present his results during my summer at PRHI. He told a heartbreaking story about a man who came into the hospital for a simple, low risk surgical procedure. He should have spent a few days in the hospital. But he acquired an infection, became gravely ill and was forced to spend the rest of his life in a long term care setting. Dr. Shannon’s passion for improving patient safety and his belief in the program were clear. It was easy for me to see how he inspired his staff and colleagues.
The Allegheny General team tracked their results in real time. According to the PRHI Executive Summary report, Allegheny General Hospital saw results within Dr. Shannon’s goal of 90 days. Between 2003 and 2006, the Medical Intensive Care Unit (MICU) and the Coronary Care Unit (CCU) saw a 95 percent reduction in central line infections -- and they brought the number of deaths associated with these infections to zero.
They quickly realized that maintaining their progress would require continued commitment and education -- especially when they discovered new medical residents weren’t adhering to the hospital’s standardized IV procedures. Another physician at Allegheny General, CCU Medical Director Dr. Jerome Granato, received a grant from PRHI’s parent organization, the Jewish Healthcare Foundation, to create a curriculum that would sustain the “culture of change” started by Dr. Shannon.
The program instructed new doctors and nurses in the perfecting care quality concepts and made sure they were well versed in the standardized procedures needed for safe central line IV insertion. For example -- always wash your hands before you start. It sounds simple (and it is), but busy doctors don’t always take the time to do it, and the consequences can be very serious. The culture of change also empowers nurses to enforce new policies, Dr. Granato told PRHI:
Doctors travel from unit to unit: the nurses come to work in that unit every day, month and year. Suddenly, we have nurses with the confidence and the authority to stop a procedure. It never used to happen, but now I might hear a nurse say, ‘You know, Doctor, you’re not adhering to policy. Please stop.’ Or ‘Doctor, this line has been in for two days. Can we take it out?’ That is revolutionary shift, and it’s taken three years to create a self sustaining environment for it.
Using a similar strategy, the
VA hospital in Pittsburgh managed to drive down the rates of methicillin-resistant staphylococcus aureus (MRSA) infections in one of their post-surgical units. With a combination of perfecting patient care philosophy and a ready supply of gloves, gowns, and hand sanitation supplies, MRSA infection rates fell from .94 infections per 1000 bed days of care in 2002 to.27 by per 1000 days in 2004. The VA also screened patients for any MRSA infection or colonization when they entered and when they left the hospital.
I was able to visit the VA to see the program in action. Even with standardized procedures in place, constant learning, and open communication were key to the continued success of patient safety initiatives. MRSA bacteria tends to colonize on the nose, making it the best place to look when you are screening a patient for infection. But MRSA tends to colonize on the outside of the nose, not the inside where workers tended to swab -- another example of the need to standardize procedures to ensure effectiveness.
The
CDC estimates that almost 100,000 people die every year from hospital acquired infections in the United States.
As we’ve written before, we’ve seen progress in fighting hospital acquired infections, but a lot remains to be done. Experts disagree on precisely how much HAIs cost, and how much we can save by reducing them. The CDC puts the direct cost of HAIs to U.S. hospitals somewhere between
$28.4 and $33.8 billion annually, with the potential to save up to $31.5 billion by preventing infections. We may not be sure how much money reducing HAIs saves. But we do know that it definitely saves lives.
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