California pediatric ICPs link programs via computer

Key goals include benchmarking

Infection control professionals at seven unaffiliated children’s hospitals in California have linked up in a novel network to benchmark infection rate data and standardize practices and policies. While focusing on their common pediatric interests, the arrangement could serve as a model for similar partnerships by other types of hospitals and health care facilities, organizers say.

Dubbed the California Children’s Hospital Association Infection Control Consortium, the group includes pediatric hospitals in Stanford, Oakland, Fresno, Los Angeles, Long Beach, Orange and San Diego. The consortium was founded last year after some of the ICPs realized that the proverbial wheel was occasionally being reinvented at the various hospitals — even though an informal network of information sharing already was in place.

"It seemed like we were all using each other for different policies and procedures, questions about benchmarking, but we didn’t have a good system for gathering all of the data and being able to standardize our practices," says Chris Abe, BSN, RN, CIC, HEM, one of the founders of the program and manager of infection control and occupational health and safety at Children’s Hospital & Health Center in San Diego.

ICPs communicate through e-mail

With similar patient populations, it made sense that practices could be standardized among the hospitals after they all agreed on the best approach to a given clinical situation. To facilitate such decisions, the ICPs now are connected by computer via e-mail through the Internet, and they meet in person on a quarterly basis.

Initial plans call for standardizing infection control practices and procedures in such areas as employee health, physician health, post-exposure follow-up, tuberculosis control plans, intravenous therapy, respiratory therapy, and patient isolation. Though the consortium is just getting under way, the hospitals have agreed initially to a standard infection control policy for physician health. (See related story, above.) In addition to standardizing practices, the network allows the hospitals to compare and benchmark infection rate data.

"I use the [data] as a benchmark for our infection control committee," Abe says. "It is really nice when the physicians say, ‘What are the other children’s hospitals doing?’ I now have that information for them."

The benchmarking form currently being used by the hospitals allows the ICPs to gather and compare data on bloodstream infections and pneumonias in neonatal and pediatric intensive care units. (See benchmarking form, p. 12.)

"We sat down as a group, and we decided surveillance of those types of infections in those areas of the hospital would give us the most bang for our buck," says Gregg Pullen, MT(ASCP)M, RM(AAM), infection control manager at Valley Children’s Hospital in Fresno. "Those are the high-risk areas and the most severe infections."

The forms are filled out by the respective ICPs monthly and mailed to a designated ICP for compilation and rate calculation, he explains. As with all data shared between the hospitals, the consortium operates with complete confidentiality and hospital identifiers are not used for the data reported to the various infection control committees, he says.

"Our goal is to look at our infection rates as a group — look at the highs and the lows — and try and analyze why some of us are higher than others," he says. "Maybe we have different patient populations we could analyze. If we see that our infection rates are in the same order of magnitude, then we are going to collaborate to develop strategies as a group to reduce our infection rates in particular areas."

Other major goals of the program include developing consensus positions on important infection control issues and conducting collaborative infection control studies. The first proposed study is comparing 24-hour vs. 72-hour hang times for total parenteral nutrition (TPN).

Multiple hospitals means statistical power

"We think this is a study that really needs to be done in pediatrics, and we are hoping with the power of our multiple hospitals we will have enough patients to answer the question definitely: whether hanging TPN solutions for up to 72 hours in high-risk pediatric patients is safe or not," Pullen says. "Our hypothesis is that it is safe and we want to prove it. It could have a dramatic cost savings because preparation of the TPN solutions by the pharmacy departments is very labor-intensive."

Such studies will be undertaken on an ongoing basis by the hospitals, which also are exploring the possibilities for group product evaluation and purchasing.

"We think that is a real important mission for the consortium," Pullen says. "That is one of the areas where we will be able to impact on costs and still maintain a high level of quality."

While consensus positions are the goal, the ICPs realize not every policy will be adopted by every hospital, he adds. For example, some hospitals have been more receptive than others to the initial physician health policy adopted by the group, but the hope is that it will be eventually adopted by all facilities, Pullen says.

"We won’t necessarily always be successful because sometimes there are roadblocks by administration or clinical staff at our hospitals," Pullen says. " But we feel it is the right thing to do, it is in the best interest of our patients, and it is consistent with our mission, which is to prevent infection transmission."

Regardless, the ongoing dialogue inherent in such an arrangement is important on its face as ICPs encounter different infections and share experiences. In doing so, the clinicians bring different levels of expertise and particular interests into the collaboration, he notes. Such data sharing includes rapid e-mail exchanges on potentially epidemiologically important infections, such as a recent consortiumwide inquiry from one ICP about incoming cases of E. coli. Theoretically, such statewide networks could hasten detection of important outbreaks or emerging pathogens.

"We think it would be valuable for other hospitals in other areas of the country, whether they be pediatric or otherwise," Pullen says. "There is a need out there. At a lot of hospitals, [ICPs] feel isolated and feel like they don’t have enough patients and contact with other hospitals to know how they are doing."

[Editor’s note: For more information about the consortium contact Gregg Pullen at Valley Children’s Hospital, 3252 N. Millbrook Ave., Fresno, CA 93703. Telephone: (209) 243-5170; fax: (209) 243-5286; or e-mail: pullen@ucsfresno.edu.]