When it comes to healthcare-acquired infections, a perfect score is zero. But while trying to keep HAIs — such as central line bloodstream infections, catheter-associated urinary tract infections and Clostridioides difficile infections — as low as possible, the goal of zero remains elusive at hospitals.
Not so at New York City-based Mount Sinai Beth Israel, where the infection prevention team has seen its HAIs drop to zero with those three infections, thanks to always-evolving protocols and communication between teams, Waleed Javaid, MD, epidemiologist and director of infection prevention and control at the hospital, said June 21 on the American Hospital Association's podcast "Advancing Health."
"In 2022, the hospital achieved zero harms by following fundamental protocols with consistency and efficiency," according to an AHA report on the podcast. "Their remarkable results include a standardized utilization ratio for central lines at less than 40 percent of the national average and indwelling urinary catheter SUR at less than 70 percent."
Dr. Javaid said other healthcare systems can emulate the "tried and true strategies" he and his team have in place to keep HAIs at bay. At MSBI, preventing HAIs is an all-hands-on-deck effort. Infection prevention is a priority for all members of the care teams, and Dr. Javaid said the processes are constantly being reviewed and improved. When tweaks are made to existing protocols or new initiatives are launched, there is hospitalwide adoption backed by ongoing training.
To keep HAI stats around zero, top priority is communication, Dr. Javaid said. Infection rates are discussed among leaders, unit teams and during rounding. There is always dialogue about the "how" and "why" infections happen to help front-line staff to better prevent them and also give them the "confidence to voice their concerns and identify potential problems, which helps mitigate these issues before they result in hospital-onset infections," Dr. Javaid said.
On the communication front, the infection prevention team emails all appropriate caregivers two lists daily — one of patients with Foley catheters and a second of patients with central lines. The emails also include important details about how long the device has been in use with each patient. The care of each and every line and catheter is documented and shared with clinicians.
At the same time, the infection prevention team requests corresponding information in return about each patient's current medical needs regarding these devices, including a list of any patients with multiple central lines or femoral lines.
When all members of the care team are in the loop for their respective patients, they are able to meet high reliability standards and, moreover, can remove lines and Foleys at the earliest point of care before an infection can set in. Dr. Javaid said all eyes are on preventing unnecessary devices from being inserted in the first place.
"Low device utilization rates are the key to [our] success," he said. "If there is no device, no risk for device-associated infection exists, and if there are a low number of devices, it is easier to focus efforts to better care for these devices."