St. Mary works to wash away infections

The hospital has been recognized for reducing the rates of infection associated with being hospitalized.

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Sheila's medical device clipped on. June 10, 2011

WALLA WALLA -- Inside every American hospital is an invisible, microscopic enemy that causes immense damage.

Providence St. Mary Medical Center in Walla Walla, however, was recently rewarded for taking a healthy swing at this particular enemy.

This unseen threat comes in the form of "HAI," or health-care associated infection, which affects about 1.7 million Americans each year and kills about 99,000.

Such infections are caused by a wide variety of common and unusual bacteria, fungi and viruses during the course of receiving medical care, according to the Centers for Disease Control and Prevention.

"Medical advances have brought lifesaving care to patients in need, yet many of those advances come with a risk of HAI. These infections related to medical care can be devastating and even deadly," the agency said.

Bloodstream infections represent the eighth leading cause of death in the United States, according to the CDC's infectious disease report. "Infections acquired in the hospital are an important cause of death, especially those involving the bloodstream or lung."

The organization issued 1,200 recommendations for reducing such infections in heath-care facilities and the Centers for Medicare and Medicaid Services recently released data on hospital-acquired infections.

In 2008 that federal agency began reducing or denying reimbursement for the additional care required to treat patients with such infections, including bed sores and catheter-associated urinary-tract infections.

In 2007, St. Mary took a renewed look at its own rates of health-care associated infections, especially ventilator-acquired pneumonia, known in the industry as VAP.

"Although the Providence St. Mary rate seemed small, it was higher than the national average and higher than most of the other hospitals in the Providence Health & Services system," noted Kathleen Obenland, director of public relations.

"Pneumonia is the most serious of health-care acquired infections," said pulmonologist Dr. Michael Bernstein, chief medical and quality officer at St. Mary.

Next in line are catheter and surgical site infections, he said. "Anytime you have something foreign going into your body, bacteria crawls up."

VAP can occur when a patient has needed a breathing tube and mechanical help breathing for more than a few days. In the past, the typical resulting infection was considered part and parcel of such intervention, said Becky Hawkins, director of critical care services.

But that mind-set of the health-care world is changing, and fast, she said. "We learned things we could do to prevent infections."

As medicine has evolved, so have the precautions. Many of the strains of bacteria that live in hospitals are more dangerous than what's in the average home, Bernstein said. "It can go from one patient to another on room surfaces."

As medicine develops to target certain conditions -- organ transplants, rheumatoid arthritis, to name a couple -- medications are produced that depress a patient's immune system. That adds to a patient's vulnerability to bacterial infections, noted the group gathered in a St. Mary conference room. That included Yvonne Strader, director of quality management; Patty Harmon, intensive care unit supervisor; and Julie Carter, a nurse in the critical care field.

They are part of a core team that researched best practices and developed policies, procedures and tools to reduce the risks of VAP at St. Mary. Others included respiratory therapists, emergency department professionals and an "infection preventionist," one of the new terms to spring up in the field of prevention.

The plan, Hawkins said, was to move to a model "where zero (infection rate) is the only acceptable rate." And to make that success sustainable.

There was an exuberant staff buy-in on the plan, she said. "We said 'It's not OK for this to happen to people.'"

Pride in their work also factored in, Bernstein noted. With a push for transparency in the medical community and data on hospitals being made more and more public, no one wanted to see St. Mary associated with negative numbers, he said.

"This is a small community," Hawkins agreed. "You can't look people in the eye and explain why we didn't do our best."

While it costs money up front to make the necessary system-wide changes, a single case of ventilator-associated pneumonia costs nearly $18,000, according to national standards.

The changes implemented through the team's research were many. Included was positioning the head of the bed at an angle to keep lungs as clear as possible; changing the types of tubing used and educating patients and their families -- bringing them onto the team, Carter said -- and reformatting how sedation is handled.

Tubing in ventilated patients, for example, used to go down a patient's nasal passage to reach the lungs. Rethinking that route, the team realized it made more sense to insert the tube through the mouth, therefore not introducing germs from the sinuses to the process.

One of the biggest changes came from rather simple technology by creating a "vent" checklist, Carter explained. The list asks day and night shifts to check off items such as "assessment of readiness in intubate," "skin integrity assessed and charted," and "nutrition plan in place."

"Everyone wants to have every checklist done by the end of the shift," Bernstein said.

And, of course, there was a hurdle hospitals have struggled to jump over for years, the team said -- improving hand-washing rates.

"It's a huge thing," Bernstein said. "We know if you go back 10 years and asked how often staff washed their hands? It was terrible."

St. Mary has made big leaps in that area, the team said. In addition to beginning a "secret shopper" program where people spy to make sure staff is properly hand washing, the hospital installed foam sanitizer dispensers about every 50 feet in the halls and elsewhere.

"You have to go out of your way now to not wash your hands," the pulmonologist said.

Staff members also wear clip-on plastic discs that feature an upraised hand with a heart at the palm. It provides a way for professionals to remind each other to lather up, Bernstein said. "If you go into a room and you see someone hasn't washed, you can just point to the symbol."

Today's hand-washing rate at St. Mary hovers at 90 percent, the doctor said, but that's not good enough. "You want 100 percent." The national rate is about 65 percent, he added.

Perhaps the very best tool health-care professionals have is well-researched patients, Hawkins pointed out as the others nodded. "Health-care associated infection is not a hidden story anymore."

It's a much healthier way of doing things, when patients and families are paying attention, Bernstein echoed. "We encourage them to ask and be involved," he said. "We're all humans."

St. Mary's rate of VAP has stood at zero since mid-2009, said Obenland. "Not only does that spare patients the ordeal ... it also saves health-care dollars."

Hard work has brought recognition. This spring, Providence St. Mary Medical Center received a national award from the Department of Health and Human Services and Critical Care Societies Collaborate.

The Sustained Improvement Award for achievements in eliminating VAP is among the newly created awards to recognize such achievements on a national level.

The prize, however, is not this award or any other, Hawkins insisted. "We're doing it for the patients."

It's been a time of leaping, Harmon said. "We go to this conference in 2008, and get blasted for our VAP rates that were way up there," she said, holding a hand above her head. "And now we're way down here."

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