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Hospital Infection Rates, A Deadly Problem

Many people make a mad dash for the emergency room when they’re sick, but what if the hospital you chose put you at an even greater risk? KSMU’s Chasity Mayes tells us how local hospitals stack up in the challenge to eliminate infections caused by medical errors.

According to the Centers for Disease Control and prevention between 30,000 and 62,000 people die each year of catheter-related blood stream infections, or BSI in the United States.

Dr. Peter Pronovost, a professor at Johns Hopkins University, has created a checklist based program called “On the Cusp: Stop BSI” to put an end to those infections.

Sharon Burnett, the coordinator of Missouri’s “On the Cusp: Stop BSI” program says one Kansas City hospital has increased its accountability.

“They were so proud; they had gone six months [with] no infections in this particular ICU where they were tracking it. And everyday they had a sign up there you know, saying 30 days, 60 days, 90 days, 120 days, 150 days, and 180 days with no infections. And then they had one, and the staff was devastated,” says Burnett.

Although only 12 percent of hospitals in Missouri are enrolled in this program, Burnett says most are taking similar precautions like those used by Pronovost. She says hospitals with already low infection rates are only using parts of the program because although it’s effective, it’s also time consuming.

In Springfield, hospitals like St. John’s and CoxHealth aren’t currently enrolled in the program, but they are using similar checklists.

Susan Soetaert is the director of infection prevention for Cox. She says she was recently introduced to the program.

“I was just introduced to it a few weeks ago and actually approached administration about it yesterday and I think we will be doing if not the exact same thing, something very similar to that. It’s a very effective approach,” Soetaert said.

Since CoxHealth began cracking down hard on its infection rates in 2008, the health system has brought infection rates down by 47 percent.

Unfortunately, even low infection rates means there is still infection. The goal of the “On the Cusp: Stop BSI” program is to eliminate infection completely. And believe it or not, it works.

Over 100 Intensive Care Units in Michigan hospitals were the first to try out the new approach. 18 months later, it went from having a higher bloodstream infection rate than the national average to near zero infections in slightly over a year’s time. After 3 years, they’re maintaining those numbers.

So why aren’t St. John’s and Cox getting the same results? It could be because Pronovost’s program requires hospitals to follow each step, not just a few of them.

Some of the steps to the “On the Cusp: Stop BSI” program include: educating staff with fact sheets, asking providers daily if catheters could be removed, using a checklist during catheter insertion, and empowering staff to stop insertion if there is a violation of the guidelines.

St. John’s had never heard of the program, but in the last year it has reduced infection rates by 50 percent. They also use a checklist system in their attempt to reduce infection.

Judy Walker is the director of infection prevention for St. Johns.

“We follow CDC criteria and all of the latest literature. I’m sure that whatever they’re doing is similar to what we’re doing we’re just probably calling it something different. We call ours “work screen best practices” which are evidence based and we look at all different types of infection. One of them is central line associated bacterimia,” says Walker.

Pronovost says empowering nurses is the key to success with his program. Many nurses find it difficult to speak up when they see a doctor not following protocol.

Caroline Helton is the director of the Bachelor of Science in nursing program at Missouri State University.

“Do we teach the student to grab the doctor’s hand and say no no? No, we don’t teach that. But we do say to them that they can assertively say to the doctor, if they’re noticing something wrong, would you rather do this? You know, and direct them to a different way of thinking about something,” says Helton.

Cox and St. John’s both say it’s important to have an educated staff that can notice errors, but they seem to have different definitions of empowerment.

St. John’s Director of Infection Prevention, Judy Walker, explains the so-called “red rules.”

“We have produced what we call “red rules” which means you can stop the line on any situation. If anybody along the line sees something that’s not appropriate not to not only central line insertion, but surgery or other patient safety issues, anybody can stop and say let’s reevaluate without any fear of repercussions,” says Walker.

CoxHealth has a less direct approach. In a surgical setting Cox expects its team to speak up if there is a break in sterile technique, but they said it’s different when it comes to beside care.

Susan Soetaert, Director of Infection prevention at CoxHealth, tells about the checklist and observer system it uses.

“It’s an insertion checklist for when central lines are placed. Physicians place them but we also have nurses who place some of our central lines. That checklist is done by an observer, and then they turn it into my department and we compile the data looking for trends for that particular provider,” says Soetaert.

Cox also said it would stand behind any nurse who chose to let a provider know if he or she were to step outside of protocol.

Nearly three billion dollars is spent on hospital infections worldwide each year. By forcing accountability on hospitals and doctors, Provonost says both the risk of infection and the cost of healthcare will drop.

For more information you can visit our website at KSMU.org.

For KSMU News, I’m Chasity Mayes.