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How Beebe sends you home happy, healthy by reducing hospital acquired infections
As part of our commitment to continuous improvement and zero patient harm, Beebe Healthcare has taken a number of steps to reduce hospital acquired infections – infections patients can get from their care in the hospital – to keep our patients safe.
Beebe has worked tirelessly to implement steps to ensure that no patient has a hospital acquired infection while under our care.
Here are some examples of hospital acquired infections and how Beebe has been successful in sending you home safe and healthy.
CLABSIs (Central Line Associated Bloodstream Infections) Prevention
When doctors need to give fluids, blood, or medications, or do medical tests quickly, they sometimes use a central line, which is a tube placed in a large vein in the neck, chest, groin, or arm. If bacteria enter the bloodstream through the central line, it can result in a CLABSI, which is a very serious infection.
At the time of submission, Beebe has gone 166 days without a single CLABSI, thanks to the diligent efforts of many team members as of the writing of this column. Beginning in January 2018, we went 466 days – well over a year! – without a single CLABSI.
We use peripheral lines (IVs in hands or arms) rather than central lines when possible, as these reduce the risk of serious infection. One of the most important changes Beebe made to reduce the incidence of CLABSIs was creating set days to change the caps that cover the end of central line tubes. These caps are located outside the body and are removed whenever doctors or nurses need to access the line. Because the caps are used frequently, it is recommended that they be changed routinely on a set schedule to prevent infection.
With many patients receiving central lines on different days, it was difficult to keep track of when everyone’s line needed to be changed. In early 2018, nurses on the Stepdown Unit proposed an alternate method: All patients, regardless of when they had their lines inserted, would have their caps changed on Sundays and Wednesdays. This method complied with the best practice recommendation. After a trial on Stepdown, led by Nurse Manager Kerri Wiggins, RN, the method was adopted throughout the hospital. Additionally, the Vascular Access Team rounds on all patients with central lines, monitors that the cap changes occur, and puts into action other best practices to prevent these types of infections.
Preventing CAUTIs (Catheter-Associated Urinary Tract Infections)
Sometimes when patients are very ill, they need very precise measuring of their urine and so may need a catheter inserted into their bladder. If bacteria enter the urinary tract through the catheter, a catheter-associated urinary tract infection or CAUTI can occur.
There are several types of catheters, and not every patient needs one that has to stay in for days or a long time. By reducing the usage of catheters and the duration for which they are used, Beebe has drastically reduced the incidence of CAUTIs.
Practices like impeccable hand hygiene and constantly asking the question, “Does this patient really need a catheter to remain in them?” have led us to regularly achieving more than 100 days without a single CAUTI.
Clostrioides difficile Bacterial Infection: What is C. Diff?
Clostrioides difficile, commonly known as C. diff, is a bacterium that causes diarrhea and colitis (an inflammation of the colon). It is serious, and estimated to cause almost half a million illnesses in the United States each year. About 1 in 5 patients who get C. diff will get it again.
Patients who are taking antibiotics are at an increased risk of C. diff, because antibiotics can wipe out good gut bacteria along with bad bacteria elsewhere in the body. For this reason, physicians must always confirm the appropriateness of antibiotics when placing an order for them in our electronic medical records system. That “pause” reduces the over prescription of antibiotics, helping to lower patients’ risk of C. diff.
Because C. diff is contagious, two of the best prevention measures we can take are being diligent in our use of hand hygiene practices when caring for C. diff patients and disinfecting rooms after they are vacated by C. diff patients.
A close partnership between Beebe’s Nursing Department and Beebe’s Environmental Services Department has been instrumental in ensuring that room disinfection happens as quickly as possible. Rooms vacated by C. diff patients are treated using the Halo Disinfection™ system, which evenly coats all surfaces in a room with a disinfecting mist. Operating rooms and other high-risk areas are also regularly fogged to reduce the risk of C. diff and kill other germs that cause infections.
Surgical Site Infections
There is a risk of infection anytime surgery is performed, but by adhering to evidence-based practices, Beebe has brought its overall rate of surgical site infections (SSIs) to less than 1%, well below the national average.
The Enhanced Recovery After Surgery (ERAS) program, launched in 2017, has been critical to this success. The ERAS team, led by Teresa Hitchens, MSN, RN, CNOR, CRNFA(E), CPHQ, Quality Outcomes Analyst, and James Spellman, MD, Chief of Surgery, conducted an analysis to identify gaps between evidence-based practices and current practices at Beebe, then implemented an education program to make changes where necessary.
The ERAS program touches many aspects of surgery, but several practices used during actual procedures have been critical to reducing surgical site infections, particularly for colorectal surgery patients. These include changing into a new (additional) set of clothes during the surgery and using new instruments when closing the wound to minimize the introduction of bacteria. All patients are also bathed with a 2% Chlorhexidine disinfectant solution just prior to surgery.
At Beebe, the safety of our patients is our highest priority and the responsibility of every team member. We are very proud of what we have achieved so far, and continue to maintain our focus on bringing the number of hospital-acquired infections in our health system to zero.
Marcy Jack, JD, BSN, CPHRM, CPHQ, is a Vice President and the Chief Quality & Safety Officer at Beebe Healthcare.