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High level of teamwork cuts blood infections

Patients in intensive care generally are the most vulnerable. With compromised immune systems, they are more susceptible to infections, which can be serious and sometimes deadly, so reducing these infections is always a top priority for intensive-care units.

  When the surgical ICU at Rochester General Hospital started a program to reduce the number of bloodstream infections, it aimed for the national benchmark at the 25th percentile. Since 2009 it actually has done much better-remaining in the 10th percentile since then and currently on a streak of 19 consecutive months with no infections.

  To produce those results, the SICU team has focused on increasing education and opening communication.

  "We looked at where we were at with infection rates, then brought the team together and dissected the problem," says Cheryl Sheridan, senior vice president and chief nursing officer at Rochester General Health System. "We looked at educating the team, making sure everyone understood procedures and practices and looking at interruptions-making sure (that) if it’s a procedure that needs to be performed under a certain technique, they’re not breaking technique."

  The team came up with a "Procedure in Progress" sign to alert staff members not to enter a room during catheter insertions, and data and feedback were provided during daily staff meetings to follow results.

  During rounds each day, the team reviewed each line, examined every insertion site and ensured that dressings were changed and intact. They also used an evidence-based system called the central line bundle to insert new lines.

  The initiative became a team effort. Nurses had the power to halt procedures if precautions were not being taken, and everyone, including the housekeeping staff, was educated about his or her role in preventing infections.

  The change in culture was as important as any of the specific measures taken, Sheridan says.

  "They created a culture where anyone in the room could speak up and stop the procedure if there was a break in technique," Sheridan says. "That’s pretty significant, and that ability to speak up just further promotes that culture of safety and the priority that we protect our patients."

  At first, infections in the unit actually went up a bit, but members used this as a chance to better study what they were doing.

  "Every bloodstream infection that occurred was reviewed by the team as they examined ways they could have prevented the infection," says Linda Greene, director of infection prevention at RGHS. "When data was presented, (patient) names and faces were attached. Each infection was considered personal, as if it happened to one’s own family."

  After the initial hitch, rates have dropped steadily. In 2007 the unit had 17 infections, followed by eight in 2008. In 2009 it had only one, and the unit went all of 2010 without a single infection.

  The SICU plan fits in with a national initiative from the Healthcare Improvement Institute, which in 2006 launched a campaign to save 100,000 lives by reducing medical harm to patients during hospitalization.

  The results are good for patients, and they also save hospitals money. Bloodstream infections cost $10,000 to $30,000 per case and are responsible for 20,000 deaths nationally in critically ill patients each year.

  To Sheridan, the award reflects the work the entire unit has done to keep the infection rate down.

  "What’s really significant is it’s a team, not just one person," she says. "So this just reinforces that coming together as a team gets great patient outcomes, and everyone is extremely excited about this."           

3/18/11 (c) 2011 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or e-mail [email protected].

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