Champions for success cover bases with infection control bundles

Healthcare Purchasing News, June, 2008 by Jeannie Akridge

Under the leadership of Brian Koll, M.D., infection control chief, Beth Israel Medical Center has also had success with implementing a bundle to eliminate central line-associated BSIs, reducing rates by 95 percent institution-wide, and maintaining zero CLABs in several units for greater than a year. While costs to implement the program were $32,000, the hospital avoided $1.4 million in charges to treat patients with CLABs.

Community Health Network in Indianapolis, IN, has worked with VHA Inc. to develop a ventilator-associated pneumonia (VAP) prevention bundle throughout their five-hospital system. As a result, two of the system's adult ICUs have had zero incidence of VAP in four years and the five-hospital system has achieved zero incidence of VAP for one year.

Pitt County Memorial Hospital (PCMH) significantly reduced the rate of VAP due to methicillin-resistant Staphylococcus aureus (MRSA) in the Surgical Intensive Care Unit (SICU) with the implementation of an active surveillance program for MRSA. The facility previously practiced high-risk screening, but according to Lawler, "we believed it was important that we screen all patients coming in to create the safest environment."

With the goal of rapidly identifying, isolating and treating patients with MRSA to prevent transmission to other patients, in February 2007, PCMH--led by Keith Ramsey, M.D., medical director for infection control--began a hospital-wide (universal) active surveillance for MRSA using the BD GeneOhm MRSA real-time polymerase chain reaction (PCR) diagnostic test. With laboratory results back in three to four hours versus two days, PCMH is able to test about 150 patients a day. Subsequently the MRSA VAP rate in the SICU decreased 68 percent during the initial 12-month intervention period, from 1.74 to 0.54 per 1,000 ventilator days, and there have not been any VAPs since June 2007 in the PCMH SICU.

Peggy Thompson, R.N., BSN, CIC, director of epidemiology at Tampa General Hospital (FL) said that after they adopted bundled products usage, "We started really making changes in our (VAP) percentages at the end of 2005, that's when we really focused on the VAP bundle and implemented a mouth care kit from SAGE Products." The mouthcare kit has a toothbrush with suction, antiplaque solution, suction catheter, perox-a-mint solution, alcohol free mouthwash, oral suction adapter, toothettes with and without suction, and mouth moisturizer, designed to provide mouthcare every 2 hours.

With this change, Thompson said, "We reduced our VAP rate by 42 percent, which was a statistically significant reduction.

Thompson continued, "In August 2007, we added the usage of Kimberly-Clark's MICROCUFF Endotracheal Tube along with the mouth care kits and other VAP bundle practices. At the end of 2007 we found that when we compared VAP rates in 2006 to 2007 we had achieved a 54 percent reduction. We then went back and compared January through July 2007 rates, to August through April 2008 to determine what if any effect the implementation of the new ET tube had made. We discovered that we had achieved a 39 percent reduction in VAP, largely attributed to the new ET tube." Since August 2007, Tampa General has had three months with zero VAP rates. Thompson said this was a significant accomplishment because they were averaging the use of 75 ventilators a day during those zero rate months.