Keeping patients safe is the No. 1 priority for nursing staff in the Medical Intensive Care Unit at UTMB’s Jennie Sealy Hospital in Galveston.
For the past two years, they have been working to reduce health care-associated infections (HAIs), which patients can get while receiving medical treatment in the hospital. HAIs are among the leading threats to patient safety, affecting about one out of every 25 hospital patients at any given time, according to the Centers for Disease Control and Prevention.
“Every hospital unit has unique challenges,” said Robert Hastedt, MICU nurse manager. “In the MICU, where we tend to have frail patients who need to be admitted longer, it’s combatting two types of infections: CLABSIs and CAUTIs.”
“CLABSI” stands for central line-associated bloodstream infections, which occur when the intravenous tubes used to supply medication, nutrients and fluids to patients become host to bacteria, pumping germs straight into the patient’s bloodstream. “CAUTI,” or catheter-associated urinary tract infections, occur when germs enter the urinary tract through a urinary catheter and cause infection. Both types of infections have been associated with increased length of stay, mortality and health care costs. But both are largely preventable.
The MICU formed the Healthcare-Associated Infection Prevention Team, made up of nurses and epidemiologists, to tackle the issue head-on. The group performed an evidence-based review and found that the most important aspect to infection prevention was identifying patients who did not need a central line or urinary catheter. Fewer catheters means fewer chances for hospital-acquired infections.
“We developed a program that used evidence-based criteria to assess patients and determine whether they needed a central line or urinary catheter,” said Rachel Taylor, an MICU nurse. “It’s been a big culture change. Before this initiative, almost every patient in the ICU had a urinary catheter at all times—it was like one of the boxes nurses checked when a patient was admitted. Now, we do a true assessment of each individual’s needs.”
If a patient meets the criteria to get a urinary catheter, the nurses have been trained to follow specific interventions for infection prevention and collaborate with physicians to get the device removed as soon as it is no longer necessary. In addition, the charge nurse performs a rounding audit at the beginning of each shift to ensure staff have adhered to safety protocols and review whether any devices can be removed.
Once having the highest rates of CLABSIs and CAUTIs in the hospital, the MICU has made significant improvements over the last several months and is now one of the top performers in preventing device-associated infections. In fact, the unit has reduced their rate of the two infections to zero by decreasing its number of urinary catheter days by 24 percent and the number of central line days by 18 percent.
“We’ve hit some major records in the MICU for reducing infections,” said Hastedt. “We used to average at least one CAUTI infection per month—and now we’ve gone five months in a row without a single infection. We produce data on a monthly basis that shows our rate of incidences are steadily declining and it really provides a lot of motivation and pride among our staff.”
Robert Starkweather, an RN business analyst at UTMB who works with epidemiology, assists the MICU in determining if an infection qualifies as an HAI and ensures the correct data is submitted to the CDC. By reducing the cases of CAUTI and CLABSI, Starkweather said it also decreases the likelihood patients will acquire other infections, as well.
“A lot of these infections are connected to each other,” said Starkweather. “For example, reducing the number of CLABSI infections also lessens the risk of infections like MRSA (methicillin-resistant Staphylococcus aureus) bacteremia, because that usually goes through the central line, as well.”
What this means for patients is improved safety and outcomes, as well as a better overall hospital experience. Without the inconvenience of a central line or urinary catheter, patients are more comfortable and are able to ambulate much easier—the MICU has even introduced a new mobility project to get more ICU patients up and moving around.
“It’s been a team effort that really took the bedside nurses and physicians to make this work,” said Hastedt. “They’ve done a phenomenal job and I think we’ve passed the biggest test, which is making sure these changes stick. We knew it wouldn’t be easy and would take a lot of hard work, but we did it.”