Four 'e' principles to infection reduction
Engagement, education, execution, evaluation
The program developed at Johns Hopkins University Hospital in Baltimore that pushed catheter-related bloodstream infection rates to zero in some intensive care units is based on the following four overriding principles. Sara Cosgrove, MD, hospital epidemiologist, comments on each one as follows:
• Engagement: Creating the imperative for change. "Publicly commit that harm is not acceptable, and at your institution you are going to do everything you can to create a safe environment for patients," she said. "As far as engaging, the question you might ask is how do you make the world a better place? The executive leaders need to make the institution safe for patients but also need to create an environment in the institution that is rewarding for staff. Whereas, the team leaders can do the same thing at the unit level. And the staff really need to believe that change can happen. If you have a bunch of negative staff, you are going to have a lot of trouble getting people to make these interventions."
• Education: Providing the evidence supporting the system redesign. "Present the evidence, make it real for people and identify the changes that are needed," she said. "People want to know what they need to do to make the changes. The executive leaders need to be sent out to engage the board and medical staff. They need to do this overarching campaign to get people to pay attention. The team leaders need to make the staff know and believe the evidence. If they don't think that using maximum barrier precautions is going to make a difference they are not going to be [motivated] to use those precautions."
• Execution: Providing the materials and resources required to redesign work and ensure patients receive evidence-based interventions. "The executive leaders need to make sure the team has resources, incentives and support," she said. "I can't emphasize this enough because they have the money and the capability to let people devote time to the project. Team leaders to make sure the staff know the plan and the plan is tailored to the individual unit environment. You will find what works in a NICU may not work in a SICU. The staff need to be encouraged to learn from defects and share successes. Have regular team meetings with the whole group, allowing the staff to suggest what could be improved, what have they identified as barriers to implementing best practices."
• Evaluation: Perform rigorous data collection and analysis to determine if patient safety and clinical outcomes are improved. "The staff need to know the data and really buy-in to the fact that they are making the unit a better place to work," she said. "This is critical. You have to measure and you have to give feedback. We have gotten to the point where the nurses and the other staff in our ICUs are expecting feedback. It's also important to celebrate successes. Don't dwell just on the one catheter-associated bloodstream infection you have, but really think about how many you prevented."
The program developed at Johns Hopkins University Hospital in Baltimore that pushed catheter-related bloodstream infection rates to zero in some intensive care units is based on the following four overriding principles. Sara Cosgrove, MD, hospital epidemiologist, comments on each one as follows:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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