Keystone ICU program reduces patient mortality
Preventionists urged to be advocates
Already shown to reduce central line-associated blood stream infections (CLABSIs), a checklist protocol program has now shown to reduce mortality in ICU patients age 65 and over, researchers report.1
"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," says Peter Pronovost, MD, PhD, a co-author of the paper and a professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine.
As previously reported in Hospital Infection Control and Prevention, Pronovost and colleagues developed the Keystone Intensive Care Unit Project and implemented it in Michigan hospitals. A checklist used by clinicians to ensure aseptic technique during catheter insertion has become one of the more well known aspects of the program. It focuses on the following five key measures:
- Hand hygiene
- Full-barrier precautions during catheter insertion
- Skin cleansing with chlorhexidine
- Avoiding the femoral insertion site
- Removal of unnecessary catheters.
To evaluate whether implementation of the project was associated with reductions in hospital mortality and length of stay for older adults, the authors conducted a retrospective comparative study using data from Medicare claims. The study period (October 2001 to December 2006) spanned two years before the project was initiated to 22 months after its implementation. The study sample included hospital admissions for patients treated in 95 study hospitals in Michigan (238,937 total admissions) compared with 364 hospitals in the surrounding Midwest region (1 million total admissions). The researchers found that overall a person's chance of dying decreased by about 24% percent in Michigan after the program was implemented compared to only 16% in surrounding Midwestern states where the program was not implemented.
"This study gives us assurance that investing in large-scale, evidence-based quality improvement programs can save livesthe most important outcome for patients and doctors," says Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality. "AHRQ and others have already initiated work to expand this project nationwide to other ICUs across the country."
Indeed, the Association for Professionals in Infection Control and Epidemiology has launched a major campaign and set up a website to urge adoption of the protocol (http://CLABSI.APIC.org). The website is a part of APIC's "I Believe in Zero CLABSIs" campaign, in which infection preventionists are urged to lead efforts to eliminate these infections in their facilities The website brings together educational materials and guidance on preventing CLABSIs, which kill some 30,000 patients in the U.S. every year.
"Our goal in this [campaign] is to really engage as many infection preventionists as possible because they can be a local champion for improving care and patient safety," says APIC President Russell Olmsted, MPH, CIC, epidemiologist in Infection Prevention & Control Services at St. Joseph Mercy Health System in Ann Arbor, MI. "This is a good example of a project that has a good foundation of scientific evidence both basic research and experience implementing it in multiple settings."
The striking results of the intervention both in decreasing infections and now lowering mortality rates have shattered the old perception of simply reducing BSIs to a given benchmark range, he adds. "That whole conversation has changed now to the expectation of working toward elimination going for zero," Olmsted says.
A survey of infection preventionists conducted last year by APIC found that hospitals still struggle to prevent CLABSIs. Added financial incentives from the federal government should prompt hospitals to increase measures to eliminate the infections. Starting this year, the Centers for Medicare & Medicaid Services requires that hospitals who participate in Medicare report the number and rate of adult intensive care unit patients who acquire CLABSIs, or risk losing 2% of their Medicare payments.
Reference
- Lipitz-Snyderman A, Steinwachs D, Needham DM, et al. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: Retrospective comparative analysis. BMJ 2011;342:doi:10.1136/bmj.d219.
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