New York Hospitals Join Forces to Target Infections in ICUs

NEW YORK -- Determined to address the critically important issue of hospital-acquired infections (HAIs), 38 hospitals in the New York metropolitan area have teamed up to try to eliminate a particularly common and dangerous infection in intensive care units (ICUs): central line-associated bloodstream infections (CLABs). Sponsored by the United Hospital Fund and the Greater New York Hospital Association (GNYHA), the CLABs Quality Improvement Collaboratives early data show that two-thirds of participating hospitals have already cut their central line infection rates by more than half, and a number of hospitals have totally eliminated CLABs in their ICUs for several months. Overall, from June 2005 (when the Collaborative began) to February 2006, participating hospitals have decreased their aggregate CLAB infection rate by 50 percent -- from five infections per 1,000 central line days in ICUs to 2.5 infections per 1,000. The goal of the Collaborative is to eliminate all CLAB infections.

Central line infections are often caused by a failure to completely implement maximal sterile barrier precautions during insertion of a central line, a catheter introduced into an artery or vein to deliver medication or nutrition. Hospital patients, particularly ICU patients, requiring a central line are at often at increased risk for infection because of underlying illnesses and compromised immune systems, making the elimination of all central line-associated infections challenging. Nationally, about 5.3 CLABs develop for every 1,000 ICU patient days with a central line in place. CLABs can be deadly: 18 percent of all patients who contract CLABs (approximately 28,000 people) die from these infections each year. CLABs can also cost hospitals up to $56,000 per patient, since patients with infections have more complications, requiring additional treatments and longer lengths of stay.

Meeting the challenge of improving quality and patient safety is at the forefront of every hospitals agenda, and innovative infection control measures are essential to achieving that goal, says GNYHA President Kenneth E. Raske. Greater New York Hospital Association is proud to partner with the United Hospital Fund on a project, the CLABs Quality Improvement Collaborative, that will save lives, serve as a model for future patient safety initiatives, and save financially reeling hospitals desperately needed money.

Multidisciplinary teams of clinical and non-clinical staff at the 38 participating hospitals follow a series of protocols, including standardizing the supplies used to insert a central line via custom packs (known as the central line insertion bundle) to ensure that all the supplies are always easily accessible and available at the patient's bedside; avoidance of femoral line placement (which has a higher infection rate than other insertion locations); creating a central line certification program for doctors in training; and authorizing nurses to halt the insertion of a central line if a protocol is not being followed. The CLAB teams, which include hospital staff ranging from administrators to physicians and nurses to housekeeping staff, also incorporate the Collaboratives groundbreaking rapid cycle process that engages participants in quickly identifying goals, determining changes in practice, evaluating their effectiveness, and expanding, modifying, or scrapping those new approaches.

This Collaborative demonstrates that hospitals in an extremely competitive environment can come together, learn from each other, and produce real results that dramatically improve patient care throughout the entire New York City area, says James R. Tallon, President of United Hospital Fund, which provided grant funding to support the Collaborative. In addition, many critical lessons learned through the Collaborative can be applied to other areas of the hospital and to meet other quality and patient safety goals.

To support the Collaboratives hospitals and their multidisciplinary teams, United Hospital Fund and GNYHA staff have organized learning sessions featuring national patient safety experts, and developed communications tools such as biweekly conference calls, an electronic newsletter, and a Collaborative Web site (http://jeny.ipro.org/clabs). Plans are underway to expand the projects scope to include other areas of the hospital in which patients commonly receive central line catheters, such as operating rooms and emergency departments.

Source: United Hospital