Sorabh Dhar, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
George Alangaden, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
Dror Marchaim, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
Teena Chopra, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
Elaine Flanagan, MSA
,
Detroit Medical Center, Wayne State University, Detroit, MI
Ghulam Saydain, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
Steven Tennenberg, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
Ayman Soubani, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
Bruno Digiovine, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
Michelle Schreiber, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
M. Safwan Badr, MD
,
Detroit Medical Center, Wayne State University, Detroit, MI
Keith S. Kaye, MD, MPH
,
Detroit Medical Center, Wayne State University, Detroit, MI
Background:
There is a growing
realization that nosocomial infections are largely preventable and not necessarily
the inevitable consequence of hospitalization. As such, hospitals struggle to
keep pace with changing guidelines and regulatory requirements while also developing
infrastructures geared to preventing infections. A gap often needs to be bridged between
published recommendations and routine hospital practice – especially with
device related infections.
Objective:
To develop a
method for quality personnel to keep abreast of current preventive recommendations,
local practices, device infection rates
(central line associated infections (CLABSIs) and ventilator associated
pneumonias (VAPs)) so as to establish a platform for promoting infection
reduction, development of new
initiatives, and changing the culture of our intensive care units (ICUs).
Methods:
This joint ICU
and infection control (IC) initiative was developed in 2008 at the Detroit
Medical Center, a large eight hospital center. Three system committees were
developed: System Critical Care (SCC),
Sentinel Infection Committee (SIC), and Device Reduction Infection Panel
(DRIP). SCC serves as a forum for ICU
personell to attend, review infection rates, discuss
new initiatives, and address outstanding issues. The role of SIC is to conduct
a root cause analysis on every CLABSI and VAP occurring in ICUs. DRIP meets following SIC to ensure that CDC
criteria are applied in a standard fashion across the health system.
Results:
SCC, SIC, and DRIP helped educate and train
personnel from 14 hospital ICUs regarding CDC definitions, infection
surveillance results, and prevention strategies. Through these processes,
additional components were added to the traditional IHI
and Keystone central line and ventilator
bundles; a “real time” process for infection notification of ICU staff by IC was
created; and a standardized process for reviewing and detailing events leading
up to VAP and CLABSI was implemented.
These efforts resulted in an increased awareness regarding
device-related infection prevention, creation of ICU rounds dedicated to
management of devices, direct observation of central line insertion by quality
personnel, unit huddles at the time of each infection as part of a root cause
analysis, and design and implementation of trials of new infection prevention
technologies. These processes resulted in a 71.5% reduction in the system wide
rates of CLABSIs (from 2.6 to 0.7, p<0.001) and an 87% reduction in VAPs
(from 4.1 to 0.5, p<0.001) (graph 1).
Conclusions:
Development of
workgroups and processes to optimize infection prevention, standardize
application of infection criteria and definitions, and raise awareness of the
epidemiology of device-related infections has a significant effect in reducing
the incidence of VAP and CLABSI in our ICUs.
Graph 1
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