Doral, Fla.-based Jackson West Medical Center opened in August 2021 with a road map for preventing hospital acquired infections that is now being scaled across the system.
“From the very beginning, we built a culture where everyone is empowered to act like the CEO, because in the moments that matter most, the only person who truly matters to the patient is the caregiver in front of the patient,” Eddie Borrego, senior vice president and CEO at Jackson South and Jackson West Medical Centers and chief experience officer at Jackson Health System, told Becker’s. “We empowered staff to make the right decisions for patients. That foundation allowed our caregivers to speak up: If a nurse doesn’t believe a patient needs a Foley or a central line, they’re empowered to bring that up to the physician, infection control, or even escalate to the CNO. For us, we don’t see HAIs as hospital-acquired infections; we see them as harm events. Our goal is zero harm events.”
Since opening, the 100-bed hospital has seen a 151% increase in the number of ED visits, a 182% increase in the number of admissions, and 153% increase in the number of inpatient and ICU days — the average daily census is 99 and average number of daily ED visits is over 100. The hospital had its first and only CLABSI and MRSA cases in the ICU in January 2023.
“As difficult as that was, it gave us an opportunity to learn what was working and what wasn’t,” Mr. Borrego said.
Over the years, Jackson West Medical Center leaders have implemented a number of infection strategies that have kept HAIs at zero.
1. They created policies that define criteria for discontinuing Foleys. These encourage nurses to remove Foleys when they are no longer necessary, Vivian Barreto, BSN, RN, chief nursing officer at Jackson West Medical Center, told Becker’s.
2. After the CLABSI case, the hospital limited who could draw blood cultures from central lines to only charge nurses, nurse managers or specially trained personnel. This ensures samples are not contaminated.
3. Every morning, Ms. Barreto rounds with a multidisciplinary team, including infection prevention and nurse managers. They review every invasive device — which averages about 25 a day — to assess if the patient still meets criteria as well as ensure that lines are dated, caps are in place, and urinary bags and tubing are in order. If patients no longer meet criteria, they contact the physician to have the device removed. About once a week, Mr. Borrego also joins the morning rounds.
“When nurses see the CEO or CNO on a call, reviewing invasive lines, it signals that this work matters,” he said. “If a nurse says, ‘I spoke to the physician, but they won’t remove the Foley,’ and the CNO says, ‘I just read the record — there’s no need for it — I’m calling the doctor,’ that sends a strong message. It empowers nurses to have informed, collaborative conversations about what’s appropriate for their patients.”
4. In the ICU, patients are bathed twice every 24 hours, or once per shift.
5. Twice a week, a multidisciplinary team, including medical, nursing, administration and environmental services, conducts environmental care rounds on all units. Every patient who has been in the hospital for seven days or more has their room terminally cleaned to reduce risk of infection.
6. Any near misses are reviewed in a meeting of clinical staff and leadership.
7. New nurses receive HAI education during orientation that helps them identify the harm of HAIs and why the hospital prioritizes infection prevention. Team members also undergo ongoing training around infection prevention.
“Many new staff members don’t come in knowing all the protocols,” Olga Orozco, the hospital’s only infection prevention specialist, told Becker’s. “We educate constantly in orientation, in small groups, and during multidisciplinary rounds.”
8. Leadership encourages and backs infection prevention ideas brought forward by the front-line team. For example, one staff member suggested using UV light to clean isolation rooms for patients who had been hospitalized for more than seven days. Leadership supported and funded the project, which saw success at Jackson West and is now expanding to Jackson South.
“Innovation is messy,” Mr. Borrego said. “It doesn’t always come with an immediate ROI or a perfect checklist. We need to allow that space to try, fail, adjust, and try again.”
Jackson West’s road map is now being scaled and implemented at Miami-based Jackson South Medical Center, a 262-bed hospital, which has seen a dramatic reduction in device days and HAIs, he said. The road map is expected to be rolled out across the system in coming years.
