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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

APIC 2011: ‘We own this.’

(Baltimore) There has been so much hoopla about driving central line-associated bloodstream infections (CLABSIs) down to zero with checklists and bundles, that a unit that fails to achieve such success may take it somewhat personal.

After a period of struggle, nurses on a surgical intensive care unit (SICU) at a large academic medical center did just that, deciding to “own the problem” until they cut bloodstream infections to zero and saved more than $200,000 during a six-month period. Of greatest consequence: Lives were saved. Researchers estimated that two or three patients were spared fatal infections.

Ultimately, culture change in a given unit may be as big a factor as any checklist or infection prevention tactic, said Michael Anne Preas, RN, BSN, CIC, infection preventionist at the University of Maryland Medical Center.

“It was truly a back-to-basics effort – these were just best practices at a granular level, led by the unit themselves,” she said recently in Baltimore at the 211 educational conference of the Association for Professionals in Infection Control and Epidemiology. “The nurses on the unit took ownership of best practices and drove the change. When you have one of your own in the lead, and are reminding each other and encouraging each other to do your best, everybody gets on board, and that is what we saw.”

Preas played a key role in the project, but credits the culture change within the unit for making a change that will endure.

“Until the staff actually owned doing that work, they were struggling with their [infection] rates,” she said. “We are using this as a business case to make sure that the units are well staffed, so that they can do the work of infection control. I’m the one who got the publicity for being the germ cop, but really this whole concept of going around and saying ‘You’re doing this correctly or incorrectly’ [has diminishing returns]. One IP can make an impact, but can’t make the difference in the way the unit can by changing their own internal culture.”

Morale was not so high at the outset, as the unit staff were coming to terms with the thought that maybe there was little more they could do for their patients. “We had a CLABSI rate [in this unit] that was significantly higher than the national average,” she said. “They had many best practices in place — they used the standard central line cart for all of the placement of their catheters. They used sterile barrier

precautions when they inserted these lines and used a checklist.”

When infections continued to occur, there was some thought that the patient severity of illness in the SICU was too high to overcome with interventions.

“Frankly, the staff in this particular SICU believed that they could not get to zero,” Preas said.

They did.