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
Implementation of an Infection Prevention Bundle to Reduce Surgical Site Infections and Cost Following Spine Surgery. JAMA Surgery 2016; Online First July 20, 2016