1
|
Al-Sofyani KA, Uddin MS. Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients? BMC Infect Dis 2022; 22:598. [PMID: 35799133 PMCID: PMC9264698 DOI: 10.1186/s12879-022-07571-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In children in the ICU, catheter-related bloodstream infections (CRBSI) have also been linked to mortality, morbidity, and healthcare costs. Although CRBSI poses many potential risks, including the need to avoid femoral access, there is debate regarding whether jugular access is preferable to femoral access in adults. Study reports support both perspectives. There is no consensus in meta-analyses. Children have yet to be examined in depth. Based on compliance with the central line bundle check lists, we aim to determine CRBSI risk in pediatric intensive care units for patients with non-tunneled femoral and internal jugular venous access. METHODS A retrospective cohort study was conducted on patients with central venous catheters in the pediatric ICU of King Abdulaziz University Hospital between January 1st, 2017 and January 30th, 2018. For the post-match balance, we use a standardized mean difference of less than 0.1 after inverse probability treatment weighting for all baseline covariates, and then we draw causal conclusions. As a final step, the Rosenbaum sensitivity test was applied to see if any bias influenced the results. RESULTS We recorded 145 central lines and 1463 central line days with 49 femoral accesses (33.79%) and 96 internal jugular accesses (66.21%). CRBSI per 1000 central line days are 4.10, along with standardized infections of 3.16. CRBSI risk differed between non-tunneled femoral vein access and internal jugular vein access by 0.074 (- 0.021, 0.167), P-value 0.06, and relative risk was 4.67 (0.87-25.05). Using our model, the actual probability was 4.14% (0.01-0.074) and the counterfactual probability was 2.79% (- 0.006, 0.062). An unobserved confounding factor was not identified in the sensitivity analysis. CONCLUSIONS So long as the central line bundle is maintained, a femoral line does not increase the risk of CRBSI. Causation can be determined through propensity score weighting, as this is a trustworthy method of estimating causality. There is no better way to gain further insight in this regard than through the use of randomized, double-blinded, multicenter studies.
Collapse
Affiliation(s)
- Khouloud Abdulrhman Al-Sofyani
- Department of Pediatric, Pediatric Intensive Care Unit, King Abdulaziz University Hospital, Faculty of Medicine and Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Shahab Uddin
- Pediatric Department, Ministry of National Guard Health Affairs, Dammam, Saudi Arabia.
| |
Collapse
|
2
|
Ensaldo-Carrasco E, Suarez-Ortegon MF, Carson-Stevens A, Cresswell K, Bedi R, Sheikh A. Patient Safety Incidents and Adverse Events in Ambulatory Dental Care: A Systematic Scoping Review. J Patient Saf 2021; 17:381-391. [PMID: 27611771 DOI: 10.1097/pts.0000000000000316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There have been efforts to understand the epidemiology of iatrogenic harm in hospitals and primary care and to improve the safety of care provision. There has in contrast been very limited progress in relation to the safety of ambulatory dental care. OBJECTIVES To provide a comprehensive overview of the range and frequencies of existing evidence on patient safety incidents and adverse events in ambulatory dentistry. METHODS We searched MEDLINE and EMBASE for articles reporting events that could have or did result in unnecessary harm in ambulatory dental care. We extracted and synthesized data on the types and frequencies of patient safety incidents and adverse events. RESULTS Forty articles were included. We found that the frequencies varied very widely between studies; this reflected differences in definitions, populations studied, and sampling strategies. The main 5 PSIs we identified were errors in diagnosis and examination, treatment planning, communication, procedural errors, and the accidental ingestion or inhalation of foreign objects. However, little attention was paid to wider organizational issues. CONCLUSIONS Patient safety research in dentistry is immature because current evidence cannot provide reliable estimates on the frequency of patient safety incidents in ambulatory dental care or the associated disease burden. Well-designed epidemiological investigations are needed that also investigate contributory factors.
Collapse
Affiliation(s)
| | - Milton Fabian Suarez-Ortegon
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Scotland, UK
| | - Andrew Carson-Stevens
- Patient Safety Research Lead, Primary and Emergency Care Research (PRIME) Centre, Cardiff University, Wales; and Visiting Professor of Healthcare Improvement, Department of Family Practice, University of British Columbia
| | | | - Raman Bedi
- Professor and Head Centre for International Child Oral Health. King's College London Dental Institute at Guy's, King's College and St Thomas's Hospitals, Division of Population and Patient Health, King's College London, UK
| | - Aziz Sheikh
- Professor of Primary Care Research & Development and Co-Director, Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Scotland
| |
Collapse
|
3
|
Borgert M, Binnekade J, Paulus F, Goossens A, Dongelmans D. A flowchart for building evidence-based care bundles in intensive care: based on a systematic review. Int J Qual Health Care 2017; 29:163-175. [PMID: 28453823 DOI: 10.1093/intqhc/mzx009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/23/2017] [Indexed: 01/22/2023] Open
Abstract
Purpose The Institute for Healthcare Improvement is the founder of the care bundled approach and described the methods used on how to develop care bundles. However, other useful methods are published as well. In this systematic review, we identified what different methods were used to design care bundles in intensive care units. The results were used to build a comprehensive flowchart to guide through the care bundle design process. Data sources Electronic databases were searched for eligible studies in PubMed, EMBASE and CINAHL from January 2001 to August 2014. Study selection There were no restrictions on the types of study design eligible for inclusion. Methodological quality was assessed by using the Downs & Black-checklist or Appraisal of Guidelines, REsearch and Evaluation II. Data extraction Data extraction was independently performed by two reviewers. Results of data synthesis A total of 4665 records were screened and 18 studies were finally included. The complete process of designing bundles was reported in 33% (6/18). In 50% (9/18), one of the process steps was described. A narrative report was written about care bundles in general in 17% (3/18). We built a comprehensive flowchart to visualize and structure the process of designing care bundles. Conclusion We identified useful methods for designing evidence-based care bundles. We built a comprehensive flowchart to provide an overview of the methods used to design care bundles so that others could choose their own applicable method. It guides through all necessary steps in the process of designing care bundles.
Collapse
Affiliation(s)
- Marjon Borgert
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Jan Binnekade
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Astrid Goossens
- Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Dave Dongelmans
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| |
Collapse
|
4
|
The Iowa Disinfection Cleaning Project: Opportunities, Successes, and Challenges of a Structured Intervention Program in 56 Hospitals. Infect Control Hosp Epidemiol 2017; 38:960-965. [DOI: 10.1017/ice.2017.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVEA diverse group of hospitals in Iowa implemented a program to objectively evaluate and improve the thoroughness of disinfection cleaning of near-patient surfaces. Administrative benefits of, challenges of, and impediments to the program were also evaluated.METHODSWe conducted a prospective, quasi-experimental pre-/postintervention trial to improve the thoroughness of terminal room disinfection cleaning. Infection preventionists utilized an objective cleaning performance monitoring system (DAZO) to evaluate the thoroughness of disinfection cleaning (TDC) expressed as a proportion of objects confirmed to have been cleaned (numerator) to objects to be cleaned per hospital policy (denominator)×100. Data analysis, educational interventions, and objective performance feedback were modeled on previously published studies using the same monitoring tool. Programmatic analysis utilized unstructured and structured information from participants irrespective of whether they participated in the process improvement aspects to the program.RESULTSInitially, the overall TDC was 61% in 56 hospitals. Hospitals completing 1 or 2 feedback cycles improved their TDC percentages significantly (P<.0001; P<.005). Overall, 22 hospitals (39.3%) completed all 3 study phases and significantly increased their TDC percentages to a mean of 89%. Moreover, 6 hospitals maintained the program beyond the planned study period and sustained TDC percentages >90% for at least 38 months. A survey of infection preventionists found that lack of time and staff turnover were the most common reasons for terminating the study early.CONCLUSIONThe study confirmed that hospitals using this program can improve their TDC percentages significantly. Hospitals must invest resources to improve cleaning and to sustain their gains.Infect Control Hosp Epidemiol 2017;38:960–965
Collapse
|
5
|
Abstract
Despite concerted effort to improve quality and safety, high reliability remains a distant goal. Although this likely reflects the challenge of organizational change, persistent controversy over basic issues suggests that weaknesses in conceptual models may contribute. The essence of operational improvement is organizational learning. This article presents a framework for identifying leverage points for improvement based on organizational learning theory and applies it to an analysis of current practice and controversy. Organizations learn from others, from defects, from measurement, and from mindfulness. These learning modes correspond with contemporary themes of collaboration, no blame for human error, accountability for performance, and managing the unexpected. The collaborative model has dominated improvement efforts. Greater attention to the underdeveloped modes of organizational learning may foster more rapid progress in patient safety by increasing organizational capabilities, strengthening a culture of safety, and fixing more of the process problems that contribute to patient harm.
Collapse
Affiliation(s)
- Marc T Edwards
- 1 QA to QI Patient Safety Organization, West Hartford, CT
| |
Collapse
|
6
|
Cumulative impact of periodic top-down communications on infection prevention practices and outcomes in two units. Health Care Manage Rev 2016; 40:324-36. [PMID: 25120195 DOI: 10.1097/hmr.0000000000000038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The problem of interest in this study is the challenge of consistent implementation of evidence-based infection prevention practices at the unit level, a challenge broadly characterized as "change implementation failure." The theoretical literature suggests that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Our study sought to both validate the theoretical literature and address this gap. PURPOSE Correspondingly, this study posed two research questions. (1) What is the impact of periodic "top-down" communications on practice change at the unit level? (2) What are the "unit-level" communication dynamics enabling practice changes? Whereas this article focuses on addressing the first question, the second question has been addressed in an earlier Health Care Management Review article (Rangachari et al., 2013). METHODS A prospective study was conducted in two intensive care units at an academic health center. Both units had low baseline adherence to central line bundle (CLB) and higher-than-expected catheter-related bloodstream infections (CRBSIs). Periodic top-down communication interventions were conducted over 52 weeks to promote CLB adherence in both units. Simultaneously, the study examined (a) unit-level communication dynamics related to CLB through weekly "communication logs," completed by unit physicians, nurses, and managers, and (b) unit outcomes, that is, CLB adherence and CRBSI rates. FINDINGS Both units showed increased adherence to CLB and significant, sustained declines in CRBSIs. Results showed that the interventions cumulatively had a significant negative (desired) impact on "catheter days," that is, central catheter use. PRACTICE IMPLICATIONS Results help validate the theoretical literature and identify evidence-based management strategies for practice change at the unit level. They suggest that periodic top-down communications have the potential to modify interprofessional knowledge exchanges and enable practice change at the unit level, leading to significantly improved outcomes and reduced costs.
Collapse
|
7
|
Berenholtz SM, Lubomski LH, Weeks K, Goeschel CA, Marsteller JA, Pham JC, Sawyer MD, Thompson DA, Winters BD, Cosgrove SE, Yang T, Louis TA, Lucas BM, George CT, Watson SR, Albert-Lesher MI, Andre JRS, Combes JR, Bohr D, Hines SC, Battles JB, Pronovost PJ. Eliminating Central Line–Associated Bloodstream Infections: A National Patient Safety Imperative. Infect Control Hosp Epidemiol 2016; 35:56-62. [DOI: 10.1086/674384] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Several studies demonstrating that central line–associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.Methods.We conducted a collaborative cohort study to evaluate the impact of the national “On the CUSP: Stop BSI” program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented.Results.A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16–18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50–0.65) at 16–18 months after implementation.Conclusion.Coincident with the implementation of the national “On the CUSP: Stop BSI” program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.
Collapse
|
8
|
Abstract
Customer satisfaction is the most important parameter for judging the quality of service being provided by a service provider to the customer. Positive feedback from the customer leads to the goodwill of service providers in the market, which indirectly expands their business, whereas negative feedback makes it shrink. This theory is also applicable to health care providers. Nowadays, patients are aware of their rights in terms of health care services and the quality of health care services being delivered to them. There are various tools or indicators which are set to provide the quality of services for patients without any acquired infection. In this article, literature review has been done to study various tools given by distinct authors and customer satisfaction and quality indicators given by health organizations to measure quality in the health care sector.
Collapse
|
9
|
Guidance for infection prevention and healthcare epidemiology programs: healthcare epidemiologist skills and competencies. Infect Control Hosp Epidemiol 2016; 36:369-80. [PMID: 25998192 DOI: 10.1017/ice.2014.79] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
Pronovost PJ, Cleeman JI, Wright D, Srinivasan A. Fifteen years after To Err is Human: a success story to learn from. BMJ Qual Saf 2015; 25:396-9. [PMID: 26669931 DOI: 10.1136/bmjqs-2015-004720] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/19/2015] [Indexed: 01/17/2023]
Affiliation(s)
- Peter J Pronovost
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine; Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - James I Cleeman
- Agency for Healthcare Research and Quality, Center for Quality Improvement and Patient Safety, Rockville, Maryland, USA
| | - Donald Wright
- U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Rockville, Maryland, USA
| | - Arjun Srinivasan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
11
|
Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Andrea Herepath
- Sir Roland Smith Centre for Strategic Management, Department of Entrepreneurship, Strategy and Innovation, Lancaster University Management School, Lancaster University, Lancaster, UK
- Cardiff Business School, Cardiff University, Cardiff, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
| |
Collapse
|
12
|
The evolution of knowledge exchanges enabling successful practice change in two intensive care units. Health Care Manage Rev 2015; 40:65-78. [PMID: 24153028 DOI: 10.1097/hmr.0000000000000001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as "change implementation failure." PURPOSE The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap. METHODS A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly "communication logs" completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews. FINDINGS Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in "proactive" communications-that is, communications intended to reduce infection risk-between physicians and nurses over time. Further analysis revealed that, during the early phase of the study, "champions" emerged within each unit to initiate process improvements. PRACTICE IMPLICATIONS The study helps identify evidence-based management strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation.
Collapse
|
13
|
Abstract
Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine's current use bears testimony to its effectiveness and potential. Telemedicine's widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits.
Collapse
|
14
|
Introducing the No Preventable Harms campaign: creating the safest health care system in the world, starting with catheter-associated urinary tract infection prevention. Am J Infect Control 2015; 43:254-9. [PMID: 25728151 DOI: 10.1016/j.ajic.2014.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Endemic health care-associated safety problems, including health care-associated infection, account for substantial morbidity and mortality. We outline a regional No Preventable Harms campaign to reduce these safety problems and describe the initial results from the first initiative focusing on catheter-associated urinary tract infection (CAUTI) prevention. METHODS We formed a think tank composed of multidisciplinary experts from within a 7-hospital Midwestern Veterans Affairs network to identify hospital-acquired conditions that had strong evidence on how to prevent the harm and outcome data that could be easily collected to evaluate improvement efforts. The first initiative of this campaign focused on CAUTI prevention. Quantitative data on CAUTI rates and qualitative data from site visit interviews were used to evaluate the initiative. RESULTS Quantitative data showed a significant reduction in CAUTI rates per 1,000 catheter days for nonintensive care units across the region (2.4 preinitiative and 0.8 postinitiative; P = .001), but no improvement in the intensive care unit rate (1.4 preinitiative and 2.1 postinitiative; P = .16). Themes that emerged from our qualitative data highlight the need for considering local context and the importance of communication when developing and implementing regional initiatives. CONCLUSIONS A regional collaborative can be a valuable strategy for addressing important endemic patient safety problems.
Collapse
|
15
|
Reese SM, Gilmartin H, Rich KL, Price CS. Infection prevention needs assessment in Colorado hospitals: rural and urban settings. Am J Infect Control 2014; 42:597-601. [PMID: 24837109 DOI: 10.1016/j.ajic.2014.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado. METHODS Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training. RESULTS Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs (P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication. CONCLUSIONS Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments.
Collapse
Affiliation(s)
- Sara M Reese
- Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO.
| | - Heather Gilmartin
- College of Nursing, University of Colorado-Anschutz Campus, Aurora, CO
| | - Karen L Rich
- Health and Safety Data Services Program, Colorado Department of Public Health and Environment, Denver, CO
| | - Connie S Price
- Division of Infectious Diseases, Denver Health Medical Center, Denver, CO
| |
Collapse
|
16
|
Awareness of Evidence-Based Practices Alone Does Not Translate to Implementation. Qual Manag Health Care 2013; 22:117-25. [DOI: 10.1097/qmh.0b013e31828bc21d] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Moody J, Septimus E, Hickok J, Huang SS, Platt R, Gombosev A, Terpstra L, Avery T, Lankiewicz J, Perlin JB. Infection prevention practices in adult intensive care units in a large community hospital system after implementing strategies to reduce health care-associated, methicillin-resistant Staphylococcus aureus infections. Am J Infect Control 2013; 41:126-30. [PMID: 22748841 DOI: 10.1016/j.ajic.2012.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A range of strategies and approaches have been developed for preventing health care-associated infections. Understanding the variation in practices among facilities is necessary to improve compliance with existing programs and aid the implementation of new interventions. METHODS In 2009, HCA Inc administered an electronic survey to measure compliance with evidence-based infection prevention practices as well as identify variation in products or methods, such as use of special approach technology for central vascular catheters and ventilator care. Responding adult intensive care units (ICUs) were those considering participation in a clinical trial to reduce health care-associated infections. RESULTS Responses from 99 ICUs in 55 hospitals indicated that many evidenced-based practices were used consistently, including methicillin-resistant Staphylococcus aureus (MRSA) screening and use of contact precautions for MRSA-positive patients. Other practices exhibited wide variability including discontinuation of precautions and use of antimicrobial technology or chlorhexidine patches for central vascular catheters. MRSA decolonization was not a predominant practice in ICUs. CONCLUSION In this large, community-based health care system, there was substantial variation in the products and methods to reduce health care-associated infections. Despite system-wide emphasis on basic practices as a precursor to adding special approach technologies, this survey showed that these technologies were commonplace, including in facilities where improvement in basic practices was needed.
Collapse
|
18
|
Liang SY, Marschall J. Update on emerging infections: news from the Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. Ann Emerg Med 2011; 58:447-51. [PMID: 22018400 DOI: 10.1016/j.annemergmed.2011.07.035] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stephen Y Liang
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
| | | |
Collapse
|
19
|
|
20
|
Transforming children's health care quality and outcomes-a not-so-random non-linear walk across the translational continuum. Acad Pediatr 2011; 11:S91-4. [PMID: 21570024 DOI: 10.1016/j.acap.2011.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 02/02/2011] [Accepted: 02/04/2011] [Indexed: 11/22/2022]
|
21
|
Pronovost PJ, Marsteller JA, Goeschel CA. Preventing Bloodstream Infections: A Measurable National Success Story In Quality Improvement. Health Aff (Millwood) 2011; 30:628-34. [DOI: 10.1377/hlthaff.2011.0047] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Peter J. Pronovost
- Peter J. Pronovost ( ) is a professor of anesthesiology and critical care medicine, surgery, and health policy and management at the Johns Hopkins University, in Baltimore, Maryland. He is also the director of the Quality and Safety Research Group and the director of Adult Critical Care Medicine
| | - Jill A. Marsteller
- Jill A. Marsteller is an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health
| | - Christine A. Goeschel
- Christine A. Goeschel is director of strategic development and research initiatives for the Johns Hopkins Quality and Safety Research Group and an assistant professor in the Schools of Medicine, Nursing, and Public Health at Hopkins
| |
Collapse
|