Reducing Catheter Associated Urinary Tract Infections (CAUTI’s) at a District General Hospital. Can change be sustained? | Commissioning for Quality and Innovation (CQINN) project.
This shared-learning tool describes how Chesterfield Royal Hospital developed an improvement strategy to reduce catheter-associated urinary tract infections after data revealed rates were double the national average.
Evans, M.E. et al. American Journal of Infection Control. 45(1) pp. 13-16
Background: Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015.
Conclusions: MRSA HAI rates declined significantly in acute care, SCIUs, and LTCFs over 8 years of the Veterans Affairs MRSA Prevention Initiative.
Pellegrini, J. et al. Anesthesia & Analgesia. Published online: December 1 2016
The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women’s Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged.
Saint, S. The Journal of Hospital Infection. Published online: November 28, 2016
Preventing healthcare-associated infection remains an international priority given the clinical and economic consequences of this largely preventable patient safety harm. While important strides have been made in preventing hospital infections over the past several decades, thorny issues remain, including how to consistently improve hand hygiene rates and further reduce device-related complications such as catheter-associated urinary tract infection.
Rather than relying solely on directional innovations – incremental changes that continue to serve as the bedrock of scientific advancement – perhaps we should also search for “intersectional innovations,” which represent breakthrough discoveries that emanate from the intersection of often widely divergent disciplines. Several intersectional innovations that have the potential to greatly impact infection prevention efforts include human factors engineering, sociology, and engaging the senses. Indeed, Professor Edward Joseph Lister Lowbury, the namesake of this lecture, exemplified intersectional thinking in his own life having been both an accomplished bacteriologist and poet. By incorporating approaches outside of traditional biomedical science we will hopefully provide patients with the safe care they expect and deserve.
Infection Control Today | Published online: 3 November 2016
An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study by Lin, et al. (2016) was to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine.
Twenty-five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14). A follow-up intervention occurred in Year 2 (2014-15). Demographic and vaccination data were derived from de-identified electronic medical record extractions.
A cohort of 70,549 adults seen in their respective practices (n = 24 with 1 drop out) at least once each year was followed. Baseline mean age was 55.1 years, 35 % were men, 21 % were non-white and 35 % were Hispanic. After one year, both intervention and control arms significantly (P < 0.001) increased influenza vaccination, with average increases of 2.7 to 6.5 percentage points. In regression analyses, likelihood of influenza vaccination was significantly higher in sites with lower percentages of patients with missed opportunities (P < 0.001) and, after adjusting for missed opportunities, the intervention further improved vaccination rates in Houston (lower baseline rates) but not Pittsburgh (higher baseline rates). In the follow-up intervention, the likelihood of vaccination increased for both intervention sites and those that reduced missed opportunities (P < 0.005).
The researchers say that reducing missed opportunities across the practice increases likelihood of influenza vaccination of adults. The 4 Pillars™ Practice Transformation Program provides strategies for reducing missed opportunities to vaccinate adults.
Gould, D.J. et al. Journal of Hospital Infection. Published online: October 13 2016
Background: All health workers should take responsibility for infection prevention and control (IPC). Recent reduction in key reported healthcare-associated infections in the United Kingdom is impressive but determinants of success are unknown. It is imperative to understand how IPC strategies operate as new challenges arise and threats of antimicrobial resistance increase.
Methods: We undertook a retrospective, independent evaluation of an action plan to enhance IPC and ‘ownership’ (individual accountability) for IPC introduced throughout a healthcare organisation. Twenty purposively selected informants were interviewed. Data were analysed inductively. Normalisation Process Theory (NPT) was applied to interpret the findings and explain how the action plan was operating.
Findings: Six themes emerged through inductive analysis. Theme 1: ‘Ability to make sense of ownership’ provided evidence of the first element of NPT (Coherence). Regardless of occupational group or seniority, informants understood the importance of IPC ownership and described what it entailed. They identified three prerequisites: ‘Always being vigilant’ (Theme 2), ‘The importance of access to information’ (Theme 3) and ‘Being able to learn together in a no blame culture’ (Theme 4) Data relating to each theme provided evidence of the other elements of NPT that are required to embed change: planning implementation (cognitive participation), undertaking the work necessary to achieve change (collective action) and reflection on what else is needed to promote change as part of continuous quality improvement (reflexive monitoring). Informants identified barriers (e.g. workload) and facilitators (clear lines of communication and expectations for IPC).
Conclusion: Eighteen months after implementing the action plan incorporating IPC ownership there was evidence of continuous service improvement and significant reduction in infection rates. Applying a theory that identifies factors that promote/inhibit routine incorporation (‘normalisation’) of IPC into everyday healthcare can help explain success of IPC initiatives and inform implementation.
Hickey, S. The Guardian. Published online: 15 May 2016.
Image shows electron micrograph of Escherichia coli.
Infections such as MRSA which have developed resistance to drugs have become a notorious threat in hospitals, where the bacteria can survive on surfaces for up to seven months. But a new discovery by scientists in Ireland could soon be working to combat them.
A research team led by Prof Suresh Pillai has developed a coating for everyday objects that prevents the spread of MRSA and E coli bacteria. The coating, which can be used on items such as smartphones, door handles and remote controls as well as surgical surfaces, has a 99.99% success rate in killing the bugs.
John Browne, the chief executive of Dublin-based company Kastus, which is working to commercialise the solution, says: “It is very hard to get rid of these things once they are there. Some studies have shown that with a deep clean on an [intensive care unit] ward where there is a critical care bed in one room … the entire room is cleaned with bleach over a 24-hour period and the bacteria are back on the surface within 24 hours.”