Hospital group wins award for its use of protocols

A patient safety initiative that emphasizes the importance of evidence-based protocols to fight hospital-acquired infections won recognition recently from the Joint Commission on Accreditation of Healthcare Organizations.

"We found we could change the behavior of the doctors we worked with if we could show them the evidence of what worked best," said Suzanne Brungs, R.N., project director of the Greater Cincinnati Patient Safety ICU Collaborative.

The 10-hospital collaborative won JCAHO's 2005 Ernest Amory Codman Award in the multiple organizations category. Over the past two years, the organization has received $650,000 in grants from the Agency for Healthcare Research and Quality to implement a multistage program to reduce the number of nosocomial infections.

"We won specifically for implementation of the first strategy; we addressed the number of central-line infections by using operating room compliance checklists maintained by nursing staff," said Brungs.

The second strategy, addressing correct antibiotic timing to reduce SSIs, is currently being pursued by the collaborative, she said, with the active involvement of each hospital's pharmacy department. "They are critical to making sure antibiotics are administered within 60 minutes of the first cut," said Brungs.

Efforts to involve nurses and pharmacists in such strategies are themselves a demonstration of utilization of evidence-based medicine, according to recommendations by the Surgical Care Improvement Project (SCIP), a multiorganizational effort to reduce SSIs.

"Pharmacists especially must play a decisive role in meeting standards for appropriate use of antibiotics and reducing SSIs," said Marianne Billeter, Pharm.D., a clinical pharmacist specializing in infectious disease control and a member of JCAHO's Expert Infection Control Panel, which helped design the SCIP guidelines.

Involving on-site acute care nurses was crucial to reducing infusion-related infections, said Brungs. "The nurses would check off a list as the doctors met each of the sterile barriers criteria, which were all based on established studies that showed their effectiveness in reducing infections," she said.

The nurses then gathered the data sheets and entered data into a database. The lists were also given to the infection control coordinator at each hospital, who would then "remind physicians about evidence-based practices, often with support from the critical care committee chairpersons," said Brungs. "Some of the doctors had a negative reaction to being corrected, but then we'd show them the relevant studies and that would change their behavior."

Staff nurses also reviewed the central-line carts and their contents and helped select the best full-body drape. They also met with manufacturers to develop a new insertion kit with contents to facilitate the intervention and took part in project surveys.

The net result was impressive: The collaborative's efforts resulted in an overall 65% decrease in central-line infections and increased adherence to evidence-based practices from 30% two years ago to 95%.

"Our goal is to get rid of all central-line infections," said Brungs. "And we haven't gotten rid of all of them, at least not yet. But this type of collaboration in setting standards among groups of hospitals works. Most of the hospitals are fierce competitors, but collaborative efforts have a proven record of reducing [nosocomial] infections."

So does full staff involvement. "Research shows that successful efforts to reduce infections should involve all members of a treatment team," said Cynthia LaCivita, Pharm.D., director of clinical standards and quality for ASHP.

The 10 hospitals participating in the initiative are Bethesda North Hospital, the Christ Hospital, Cincinnati Children's Hospital Medical Center, Cincinnati Veterans Affairs Medical Center, Fort Hamilton Hospital, Good Samaritan Hospital, Jewish Hospital, Mercy Hospital Mt. Airy, St. Elizabeth Medical Center, and University Hospital.

The Author Is a writer based in Gettysburg, Pa.