Michael Batchelor, president of the North Greenville Medical Campus, took it personally when he learned that his facility had the highest rate of central line (CL) infections among the six long term acute care hospitals in the state.
“My jaw just about dropped. With my nursing background, I’m real attentive to these things, and our numbers upset me. We were just starting our lean initiatives, and I was determined that we were going to do something about it,” he recalls.
That “something” became a simple, three-step program that has all but eradicated CL infections at North Greenville, saving as many as nine lives and more than $1 million dollars in unnecessary health care costs during its first 15 months.
The entire program cost the hospital $186 to implement. The only expenses were paper and ink because the work was done by hospital employees and physicians during their regular hours. All training was handled internally, and no additional staff was required.
On April 19, 2012, the National Association of Long Term Hospitals presented North Greenville with the Goldberg Innovation Award in recognition of its outstanding efforts to prevent CL infections. Batchelor accepted the award on behalf of his team.
“It really took a team approach,” he says, acknowledging the physicians and nurses who committed so many hours to make it successful. “It required a huge obligation on their part, but they made it happen.”
Regarding the $186 price tag, Batchelor believes it’s a good reminder that it doesn’t always take a lot of resources to accomplish big results. Improving hand hygiene and putting check lists in place are other ways to make a big difference without spending a lot of money, he adds.
So, what three simple steps allowed North Greenville to make such remarkable improvements in its infection rates? The first was the creation of a patient-centered quality care committee to address problems specific to North Greenville. Although the facility had been participating in the Greenville Hospital System’s efforts to improve quality and patient safety, North Greenville’s results related to CL infections were disappointing. According to North Greenville Infection Preventionist Kyle Puckett, problems at the long term acute care facility are different from problems the other hospitals in the system face.
The 45-bed facility provides adult long-term acute care for patients with medically complex problems, including cardiovascular conditions, respiratory disorders, fractures of the hip or pelvis, stroke, kidney disease, wound care, and ventilator management. Central lines are commonly used, making long-term patients more susceptible to infection.
The new quality care committee includes all perspectives, including the patient. In fact, one of the first patients asked to serve was a man who had contracted MRSA through a central line while being treated at North Greenville.
The second step was assignment of routine CL maintenance to one IV coordinator. In consultation with the physicians and nurses, the coordinator tracks all CLs and looks for opportunities to remove CLs in a timely manner, reducing the risk to the patient.
The final step is direct observation of CL access by a registered nurse to assure that the hub is scrubbed for a minimum of 15 seconds. This third step was the most difficult to implement, yet both Batchelor and Puckett consider it the most effective part of the program.
“The chief nursing executive and clinical team looked at me like I was crazy when I told them I wanted a nurse to witness each access. I knew it was not going to be popular. Once we put it in place, we began to hear comments about how difficult the new requirement was to fulfill,” Batchelor explains.
However, the executive insisted on a 30-day trial before considering any change and met with every member of the clinical team to explain why the rules were necessary to save lives and avoid unnecessary costs of treating hospital acquired infections. “It’s critical that everyone receive and understand the message regarding why we are doing what we are doing,” he says.
Puckett says it was hard for nurses to accept that they don’t always do what is right. “They knew the process, but they were not necessarily following it. It was hard for them to realize that was the cause of probably 75 percent of our central line infections. Otherwise, these steps wouldn’t have been so successful.”
They’ve come a long way, but the staff was reminded recently that CL infections will always be a threat. However, the way they respond to one is very different these days.
“We had a central line infection back in December, and the nurses were almost devastated. In the past, they would have thought it was business as usual, but now they wanted a root cause analysis,” Batchelor explains. The root cause analysis indicated a weakness in our process after orientation of new nurses. It was a process problem, not a people problem. So they strengthened the process following orientation. “Instead of thinking about punishment, we think about process improvement,” he says.
What started as an initiative to prevent CL infections has spread, and the patient care quality committee now looks at all quality indicators. They’ve found that just beginning to focus on an area at the committee level tends to improve the numbers.
“There was a large group of people that felt we couldn’t do it because once we get our patients they’ve been in the hospital for weeks or months. But we had to do it not just for financial reasons but because it’s the right thing to do,” Puckett says.
“Some people are reluctant to do the witness audit. They say it’s not possible. I want people to put the naysayers to the side and try it. It’s not as daunting an undertaking as they may think, and the results make the challenges rewarding,” she advises.