Skeptic learns true value of QI HAI prevention
Skeptic learns true value of QI HAI prevention
Manoj Jain, MD MPH, an infectious disease physician and writer, in Memphis, TN, admits he was skeptical when his hospital embarked on a quality improvement initiative to reduce hospital-acquired infections (HAIs) and he admitted it openly — in a column in the Washington Post.
His skepticism, he says, came mostly from his training and experiences. Infectious disease doctors see ICU infections every day, he says. The cases became, to him, a "price one paid" and he had never seen a campaign that had led to an actual rate decline.
But this time it did. The program was initiated by the quality improvement team. Jain says he learned that "often administrators don't realize the cost-savings that may be obtained when they invest in the infection control part. They always think of infection control as some cost of hiring another IP and so forth; yet the savings can be enormous just by looking at the days in the ICU for a particular patient. A decrease in even one or two infections can be a significant amount of savings."
Basic elements of the performance improvement plan were implementation of bundles. One was to prevent ventilator-associated infections, including components such as ensuring that the head of the bed is up or that prophylaxis for deep vein thrombosis is given. A checklist for central-line infections also was put into use, including components such as clinicians wearing masks, gowns, and gloves.
"I think we all know that these things are important. I think the key is at least that we implement them at every situation and often it will happen that doctors sort of take this for granted and don't pay attention to them. Once they're paying attention to them, I think it makes a difference. The other part of success comes from collective thinking, or a change in culture that comes from paying attention to what's important," Jain says.
Using checklists made clinicians more conscientious, he says. For instance, nurses became much more careful when inserting lines — because they knew a great deal of effort is needed in placing the line and, perhaps more importantly, that others were watching to see if a line becomes infected.
To garner compliance, Jain says the hospital started multidisciplinary rounds. Every morning an intensivist would round with the team and discuss many elements of the checklists. Nurses were trained to verify that doctors were wearing the obligatory gloves, gowns, and masks. The team included the patient's nurse, ICU charge nurse, pharmacist, dietician, respiratory therapist, case manager, social worker, physical therapist, and a palliative care nurse.
Jain says the overall strategy for change comprised four elements. One was the physician-led multidisciplinary rounds. The second was the use of bundles for VAP and central-line infections. The third was involving leadership and shifting the culture of thought about prevention of HAIs. The fourth was daily bed flow meetings in the ICU in which nurse managers discussed where patients were moving that day.
These bed flow meetings are held twice a day for 20 minutes to look at the hospital's status, prioritize interventions, review historical data, and set daily goals. Because they knew their average ED daily volume and were able to review scheduling for the catheterization lab and ICU, staff set out to make those beds available by 4 p.m. when the second meeting of the day was held.
Manoj Jain, MD MPH, an infectious disease physician and writer, in Memphis, TN, admits he was skeptical when his hospital embarked on a quality improvement initiative to reduce hospital-acquired infections (HAIs) and he admitted it openly in a column in the Washington Post.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.