Between November 2022 and October 2023, an Intermountain Health hospital prevented 38 central line-associated bloodstream infections, equal to reducing incidences by 46%, according to Heidi Wald, MD.
Three factors contributed to the success at Wheat Ridge, Colo.-based Lutheran Medical Center: a playbook for maintaining catheters, a formal process for central reporting and an adaptive module sent to nursing staff.
Before these plans to prevent CLABSI rates were cemented, "we saw deterioration in our performance across the organization," Dr. Wald told Becker's. "This was incredibly concerning. Getting that back under control so that we were delivering safe care reliably was incredibly important to us."
Dr. Wald is Intermountain's chief quality and safety officer. She assumed the position in August 2022 after serving in the same role at SCL Health, with which Intermountain merged in 2022.
At Lutheran Medical Center, there were six CLABSIs between 2018 and 2019, 13 between 2019 and 2020, zero between May 2020 and May 2021, two in June 2021 and one as of October 2023.
The turnaround is partly thanks to the infection prevention team making a playbook for before and during insertion of a catheter, and maintenance afterward. Compliance with best practices improved from 25% to 75% within five months, Dr. Wald said.
A module that offers CLABSI scenarios with multiple choice questions helped reinforce the playbook. The employee selects their answer and records their confidence level with each situation. If a confident mistake is made, the module adapts to reinforce the correct answer by adding similar questions later in the review.
"The interesting challenge as an educator is to flip somebody who's confident but wrong to select the right answer going forward," Dr. Wald said. "If you're wrong but you're not confident, fine, right? You're gonna be open to learning. But if you're wrong and you're confident, that's harder."
Based on the user's answers and knowledge, the module can take between 20 minutes and 40 minutes. The technology also tracks who might need a refresher course a few weeks later.
Lutheran Medical Center is Intermountain's pilot hospital for the effort, and the Salt Lake City-based system is rolling out the module at the eight hospitals formerly part of SCL Health, which Intermountain calls its Peaks Region.
Another feature of the module is heat mapping. For example, the medical-surgical team or new hires might consistently fail at questions about the insertion of a catheter, highlighting a need for educating those team members.
Intermountain plans to launch the module at its 24 other hospitals, and it is working on similar endeavors for catheter-associated urinary tract infections, sepsis, falls and pressure injury interventions.