Interventional Epidemiology: Ten Years of Infection Prevention Success

Background:

In 1998, BJC Healthcare developed a system-wide collaborative approach to Infection Prevention. The Infection Prevention Specialists (IPSs) at the 12 BJC hospitals establish goals and develop interventions to prevent hospital acquired infections (HAIs) and improve patient outcomes. Over the past ten years, the Infection Prevention and Epidemiology Consortium (IPEC) significantly decreased HAI rates at BJC hospitals.

Objective: IPEC’s goal is to improve infection rates by implementing systematic interventions to lower endemic HAI rates and employ rapid responses for epidemics and outbreaks. 

Methods:

IPSs use standardized definitions and data collection tools. A common database is used to generate hospital and system-wide HAI reports. IPEC uses a standardized qualitative form at each hospital to assess current practice compared to recommended practice (e.g., CDC guidelines). When practice deviations are identified at a majority of hospitals, IPEC develops interventions which are then implemented by IPS and multidisciplinary teams at each hospital. Interventions are aimed at changing practice and may include policy and procedure changes, product changes and education. For epidemic or outbreak infections, hospitals requests assistance and prepare epidemiological summaries of the problem. A “SWAT” team is assembled and follows a standard outbreak investigation process, including developing a case definition, identifying additional cases, implementing immediate control measures, and formulating and testing hypotheses. The SWAT team consists of local IPSs and MD epidemiologist; a BJC IPS, BJC MD epidemiologist, BJC clinical epidemiologist, and a data abstractor. Additional members are added as necessary. Chi square for trend is utilized for analysis of rates.

Results:

Under IPEC’s management, infection rates have decreased in all categories that have been tracked. The central line-associated bloodstream infection (CLABSI) rates decreased from 4.95 per 1000 line days in 2000 to 1.57 per 1000 line days in 2008 (OR= 0.32); ventilator associated pneumonia (VAP) from 7.86 per 1000 ventilator days in 1999 to 1.01 per 1000 ventilator days in 2008 (OR=0.13); coronary artery bypass graft (CABG) surgical site infection (SSI) from 4.73 per 100 procedures in 1999 to 1.75 per 100 procedures in 2008 (OR= 0.5).; and spinal fusion and laminectomy SSI rates from 1.51 per 100 procedures in 1999 to 0.91 in 2008 (OR=0.79).

Conclusions:

Collaboration between IPS at all system hospitals and corporate staff was accompanied by a steady decrease in rates across many types of HAI. The BJC IPEC provides a model for health systems to implement improvements across multiple types of facilities.