5 hospitals share strategies for better infection control

Preventing the transmission of healthcare-associated infections is a key part of maintaining a safe hospital environment for patients, staff and visitors. To improve infection control, organizations are making small changes that can make a big difference in this effort.

Becker's Hospital Review asked healthcare leaders to share the changes they've made in the last year. Their responses are below, presented alphabetically.

Editor's note: The following responses were lightly edited for length and clarity.  

Roberto Viau Colindres, MD
Infectious disease physician, deputy director of antimicrobial stewardship at Tufts Medical Center (Boston)

For urine cultures, we were using a reflex culture of five white blood cells per high-powered field, and we increased it to 15 white blood cells per high-powered field. What happened is the chief of infection control and antimicrobial stewardship [at the hospital] went through the charts of the patients who had had between five and 15 white blood cells per high-powered field, and she found there was not a case of urinary infection who had less than seven white blood cells per high-powered field. So we decreased the reflex culture to five white blood cells per high-powered field. That doesn't sound like a lot, but retrospectively, that would have saved us from more than 20 diagnoses of urinary tract infections over the last year, and that would have led to less antibiotic use.

Kristin Dascomb, MD
Intermountain Healthcare medical director infection prevention (Salt Lake City)

As a central infection prevention program, we empowered nurses to audit Clostridium difficile testing orders. The audit just ensured the patient had diarrhea (at least three stools per day, watery) and was not on a laxative or new tube feeds.  If either of these, the nurse was empowered to discuss with the physician as to the need for the test. In many cases, physicians review more critically and consider the patient's risks before ordering the test. It has reduced our Clostridium difficile cases in 2019 by another 20 percent, reducing false positives and excess antibiotics in our inpatient populations. 

Jeffrey Glasheen, MD
Chief quality officer of UCHealth (Aurora, Colo.)

UCHealth developed a CAUTI-reduction program that focuses on limiting placement of urinary catheters, early removal of catheters and ensuring appropriate testing of patients for urinary tract infections. As part of the undertaking, we put into place a standard approach to urinary retention that minimizes the use of catheters. These interventions have led to a 23 percent reduction in CAUTIs across our 12-hospital system in less than a year.

Rick Martinello, MD
Medical director, infection prevention, Yale New Haven (Conn.) Health

A small change we have been putting our effort toward is standardization of infection prevention practices across our healthcare system. This includes not only our metrics, but also how we present that data to our frontline staff and leadership. Also, we are completing the standardization of our infection prevention policies and our approach to staff education across our healthcare system. Standardization of our practices has a great number of benefits. We avoid duplication of effort within our infection prevention team, and the discussions required to develop consensus help us to develop a better end product for our staff and patients who may work or receive care at multiple sites within our healthcare system. They understand the process and expectations and don't experience as much variation, and finally standardization makes future change easier. When we're all starting from the same point, it is easier to make course adjustments.

Bruce Vanderhoff, MD
Senior vice president and CMO of OhioHealth (Columbus)

We are committed to doing everything we can to reduce the risk of infection for our patients. So in order to address the risk of bacteremia cases caused by peripheral IV-related complications, a multidisciplinary team was formed.

The team included physicians, nurses, representatives from supply chain, quality, informatics and others. They relied on internal quality improvement data and evidence-based practices to create a list of key opportunities and associated recommendations for improvement.

Those recommendations became the action items that we are currently implementing systemwide.

They include:

  • adopting a standardized approach to peripheral IV care
  • a nurse-driven IV removal protocol approved by the medical staff
  • reverting IV dwell time to 96 hours
  • a change to more standardized IV supplies

Thanks to the invaluable input of our providers, infection prevention experts and frontline nurses, we were able to develop and implement solutions aimed at continually improving patient outcomes.

 

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