National Initiative to Reduce Infections in Cardiac Surgery is Announced


Underscoring the importance of the infection rate information released by the CDC, the Society of Cardiovascular Anesthesiologists (SCA) Foundation today announced that the FOCUS Cardiac Surgery Patient Safety Initiative will develop, test and validate tools to eliminate infections in cardiac surgery patients, particularly catheter-related infections.

FOCUS (Flawless Operative Cardiovascular Unified Systems), a rigorous study of human error in the cardiovascular operating rooms, is a collaborative effort of the SCA, the SCA Foundation and the Johns Hopkins University Quality and Safety Research Group (QSRG) led by Peter Pronovost, MD, PhD.

In addition to anesthetists, the FOCUS initiative includes surgeons, perioperative nurses and perfusionists. Prospective observations by trained human factors engineers at five cardiac surgery sites identified hundreds of potential patient hazards that the observed team members did not recognize. Dr. Elizabeth Martinez, QSRG investigator, recently reported that these hazards included significant but unrecognized breaks in sterile procedures, including inadequate surgical skin prep and improper techniques for central line placement. “These observations demonstrate that even highly motivated and well trained surgical teams do not recognize the latent hazards in their own practices,” stated Martinez. “The FOCUS assessment and intervention tools can be used by teams to identify and correct these hazards.”

“This coordinated effort of medical societies coming together can make the cardiac operating room the standard of patient safety,” stated Bruce Spiess, MD, chair of the FOCUS Steering Committee. “Our intent is to provide flawless cardiac surgical care. It is what our patients need and deserve.” Pronovost, director of QSRG, and leading the development of the FOCUS tools, emphasized the importance of these findings, and the critical need for such assessment tools, saying, “Catheter-based infections are both deadly and largely preventable, but evidence based therapies that prevent patient death are often not translated into clinical practice. The tools developed in FOCUS will allow surgical teams to improve their culture, teamwork and communication, all vital steps in reducing infections.”

The FOCUS assessment tools and interventions will be based on those used in the Michigan Keystone ICU Project.

Pronovost’s special interest is applying research methods that improve quality of healthcare and safety. In 2008, Pronovost was awarded a MacArthur Fellows Program grant. He is facilitating World Health Organization efforts to implement patient safety programs in several countries, and leading AHRQ funded efforts to replicate the Michigan program in every state in the U.S., the District of Columbia and Puerto Rico.


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