Two recent studies
done on specialized patient populations identified combinations of
interventions that were able to reduce hospital-acquired infections (HAIs) by
over 50%. The first study utilized a bundle of evidence-based interventions in
patients undergoing spine surgery (discectomy, decompression, spinal augmentation
or spinal fusion) and found surgical site infections declined by 50% after
implementation (. Components of the bundle were:
The number needed to
treat (NNT) to prevent one infection was 47 patients. In addition to the 50
percent decline in SSIs there was an $866 cost reduction per case.
The second study involved ventilator patients in patients in neurointensive care units and found an HAI reduction of 53%
over an 18 month period. The two main interventions were (1) reducing the
number of intrahospital transports and (2) reducing
the number of urinary catheters. The
primary way intrahospital transports was reduced was
by the introduction of a mobile CT scanner so that patient needing frequent
brain imaging could have the imaging done in the neuro ICU rather than being
transported to the CT suite. Reduction
in urinary catheters was accomplished by daily assessment of the continued need
for such catheters, plus staff re-education on insertion and maintenance
techniques plus introducing a new Foley kit that simplified and standardized
the sterile insertion process Ventilator-associated
events decreased 48 %, Foley use decreased 46 %, CAUTIs decreased from
11 per 1000 catheter days to 6.2.
Given our multiple
columns on adverse events occurring in the Radiology suite (see full list below
but in particular see our October 22, 2013 Patient Safety Tip of the Week How
Safe Is Your Radiology Suite?) we would be interested to see if the
reduction in transports to Radiology also resulted in fewer overall adverse
events of other types. That may well have been the case since they also found overall
complication rate decreased 55 %, ICU length of stay decreased an average
of 1.5 days, and risk-adjusted mortality decreased 11%.
Lastly, back to one of the most important interventions to reduce HAIs: good hand hygiene. We often have difficulty convincing our healthcare workers (particularly our physicians) that better compliance with hand hygiene actually translates to fewer HAIs. That is especially a problem where levels of compliance with hand hygiene are already relatively high. Well, a recent study in CDCs Emerging Infectious Diseases journal should bolster your argument. Researchers from UNC Chapel Hill
Some of our prior
columns on patient safety issues in the radiology suite:
Our other columns on
urinary catheter-associated UTIs:
Some of our other
columns on handwashing and hand hygiene:
January 5, 2010
Hows
Your Hand Hygiene?
December 28, 2010 HAIs:
Looking In All The Wrong Places
May 24, 2011 Hand
Hygiene Resources
October 2011 Another
Unintended Consequence of Hand Hygiene Device?
March 2012 Smile
Youre
on Candid Camera
August 2012 Anesthesiology
and Surgical Infections
October 2013 HAIs:
Costs, WHO Hand Hygiene, etc.
November 18, 2014 Handwashing
Fades at End of Shift, ?Smartwatch to the Rescue
January 20, 2015 He
Didnt Wash His Hands After What!
September 2015 APICs
New Guide to Hand Hygiene Programs
November 2015 Hand
Hygiene: Paradoxical Solution?
April 2016 Nudge:
An Example for Hand Hygiene
August 2016 Hand
Hygiene: Whos Watching? Does it Matter?
References:
Implementation of an
Infection Prevention Bundle to Reduce Surgical Site Infections and Cost
Following Spine Surgery. JAMA Surgery 2016; Online First July 20, 2016
http://archsurg.jamanetwork.com/article.aspx?articleid=2534130
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