Patient safety

By Leigh Page

Materials managers are being enlisted in what is being billed as the largest patient safety collaborative of its kind—an initiative to reduce infection rates in ICUs at 70 Michigan hospitals.

The initiative has saved 1,578 lives and $165.5 million in more than 120 ICUs in its first two years. It was coordinated by the MHA Keystone Center for Patient Safety & Quality, a not-for-profit arm of the Michigan Health and Hospital Association, Lansing. MHA is funding the projects, along with member hospitals and Blue Cross Blue Shield (BCBS) of Michigan, Southfield.

“Controlling and preventing infections is a patient safety priority for Michigan’s hospitals and permeates every aspect of hospital care,” MHA President Spencer Johnson stated in a press release.

One goal of the ICU initiative, called Keystone: ICU, is to reduce intravenous catheter-related bloodstream infections (IVCRBSIs) through several changes, including introduction of chlorhexidine to clean the skin before placing a central-venous catheter, which can cut the risk of IVCRBSIs in half, say center officials.

The center reports that 40 percent of participating hospitals were not using chlorhexidine at the start of the initiative. To introduce the new product at each hospital, materials management and infection control staff worked with hospitalwide teams comprising a physician leader, nurse leader, staff nurse, pharmacist and senior executive. The initiative set a goal that within six weeks, chlorhexidine should be included in each hospital’s central-line kits and in ICUs. The center reports that within that time frame, 56 hospitals (78 percent) were stocking chlorhexidine, 46 hospitals (64 percent) had it available in their ICUs, and 43 hospitals (60 percent) included the product in their central-line insertion kits. The hospital teams also reported that the chlorhexidine central-line protocol was spreading to other high-intensity settings such as surgery and emergency departments. These areas of the hospital will be addressed in the center’s upcoming project, called Keystone: Hospital-Acquired Infections (HAI).

Other methods used in the ICU initiative to reduce IVCRBSIs were creating a central-line cart, requiring nurses to assist in central-line insertion and using a checklist to ensure compliance with guidelines.

The guidelines were created by the center by working with patient safety experts at the Johns Hopkins Quality and Safety Research Group, Baltimore. Also, the ICU initiative involved reducing ventilator-associated pneumonia (VAP).

To participate in the initiative, a physician and a nurse at each ICU had to commit 20 percent of his or her time to the project. The center processed data on compliance and outcomes from the ICUs and created monthly and quarterly performance reports for each institution. The center also sponsored conference calls at least twice a month and a Web site with tools, reference documents, blinded data and a bulletin board for hospital-to-hospital conversations.

As of March, the median IVCRBSI rate in participating ICUs was at zero for almost a year and 57 of the ICUs have gone for more than six months with no bloodstream infections from IV catheters, the center reports. VAP rates in the ICUs have been cut by 40 percent and 46 of the ICUs have gone for more than six months with no VAPs, the center adds.

Officials at BCBS of Michigan, which has earmarked $6 million for the MHA Keystone Center (including $350,000 specifically for Keystone: HAI), hope the new project will mirror the successes of the ICU initiative. “With Keystone: HAI, we hope to see results similar to the Keystone: ICU project—fewer infections, better patient outcomes and reduced hospital costs as a result of fewer infection incidences,” said Michael Schwartz, BCBS of Michigan senior vice president for network relations, contracting and pharmacy services, in a press release.

Leigh Page is a freelance writer based in Chicago.

Saving lives, days and dollars

Keystone: ICU, an initiative to reduce infections in more than 120 ICUs at 70 Michigan hospitals, scored some key successes, based on estimates covering a 15-month period from March 2004 to June 2005:

Source: MHA Keystone Center for Patient Safety & Quality, 2006

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