November 30, 2010
UW Medicine health system tackles, reduces infection rates
Katy Folk-Way plays an active role in the UW Medical Center’s (UWMC) infection control program. A UW employee and hospital volunteer, she appears on a poster to increase awareness about hand hygiene: We all help keep patients safe. Please clean your hands, the poster reads.
Her husband, Kim Folk, died at UWMC in 2005 from health-related complications following two liver transplants. He had multiple infections when he died, a fact that was noted on the death certificate, she said. “Who knows if he would have lived without the infections? But every infection we prevent now is an increased chance at survival,” she said.
All three medical centers in the UW Medicine health system—Harborview Medical Center, Northwest Hospital & Medical Center and UWMC—have witnessed recent significant improvements in infection control efforts. Harborview and UW Medical Center were recognized in October 2010 by the Washington State Hospital Association for outstanding hand hygiene practices, earning “Best Hands on Care” awards. Harborview was also recently lauded by Qualis Health with a “Safe in our hands” award that recognized the medical center’s hand hygiene improvement initiative.
Harborview Medical Center has achieved a 50 percent decrease in the number of patients with hospital-acquired MRSA (methicillin resistant staphylococcus aureus) and ventilator-associated pneumonia between 2007 and 2009. That drop comes despite a patient population uniquely prone to such infections.
“While our patients may be at an increased risk for infection due to the nature of their injuries, we can still reduce infections by doing everything we know we should be doing with every patient,” said Dr. Tim Dellit, a UW Medicine physician, associate medical director and head of infection control at Harborview Medical Center.
Northwest Hospital & Medical Center, Harborview and UWMC have implemented “secret shopper” programs to observe hand hygiene practices and, subsequently, provide a report to each patient care unit and department about how they fared. Observations have expanded to include sanitation practices assessment and use of infection precautions.
Northwest Hospital has had three central line-associated infections in the intensive care unit over the last four and one-half years, a figure that ranks well when compared with the Centers for Disease Control and Prevention’s average benchmark for similar units. The infection rate is low following implementation of several infection control procedures outlined by the Institute for Healthcare Improvement.
“Our effort to prevent infections in the hospital also includes targeted testing to identify organisms that patients bring into the hospital that may affect their care and cause complications,” said Dr. Gregory Schroedl, vice president, medical and chief quality officer at Northwest Hospital. “Screening select patients for dangerous organisms—which is conducted across the UW Medicine health system—helps us provide better care and reduces the chance of spreading infection to others.”
UWMC set a goal more than one year ago to reduce healthcare-associated infections by 50 percent. Officials there recently celebrated success, coming within a few percentage points of the goal: 46 percent reduction in central line infections. Hand hygiene efforts, audited by observations, is near-perfect at UWMC, too. The compliance rate for 1,009 observations of nurses, medical and health assistants in June 2010 was 100 percent. Overall compliance for 1,866 observations was 99 percent.
Dr. Estella Whimbey, associate medical director at UWMC and a UW Medicine physician, said support to reach these goals is coming from the highest levels. “These are ambitious goals, but we’ve dedicated the resources and teams to make this happen,” she said. “The culture here has changed by having so many people engaged.”
One big coordinated step UW Medicine has taken to wipe out central line infections is implementing a standardized education and training program for placement of central line catheters. If the training is not complete, physicians are not allowed to perform the procedure. Central line infection prevention can help reduce a patient’s length of stay in an intensive care unit (ICU), ICU mortality and overall hospital mortality.
In addition, when a healthcare-associated infection occurs within the UW Medicine system, teams on the unit perform an intensive case review to determine what could have been done differently. “It makes the case real for the teams,” said Dellit. “They attach a name and a person to that infection. Staff go from thinking about the individual patient to the impact this had on everyone on the team, including the patient and family members.”