Focused Bloodstream Infection Prevention Success Using a Team-Based Unit-Level Approach

Abstract

ISSUES: Bloodstream infection (BSI) rates and blood culture contamination (BCC) rates are not often used simultaneously to address quality issues. In this investigation, BSI rates and BCC rates were used in common to address the overall incidence of positive blood isolates (BI). PROJECT: In September 2003, IC used a data-mining surveillance service to provide each nursing unit with blood isolate incidence over an 8-month period, sorted by type of organism recovered. Key objectives were 1) instruct nursing leadership on how to present IC surveillance information, 2) focus staff attention on best practices to reduce BSI (Top 10 IC Measures to Reduce BSI), 3) peer monitoring of line maintenance practices, 4) promote use of waterless alcohol-based hand rub, and 5) provide weekly IC outcome data to all unit team members. These actions were expected to result in a decrease in BCC rates, and concurrently, BSI rates. RESULTS: An aggressive team-based approach on a 42-bed acute-care cardiac telemetry unit resulted in a reduction in the weekly average of non-duplicate bloodstream isolates from 0.69 (25 patients/36 weeks) to 0.066 (1 patient/15 weeks), a 90% reduction. The contamination rate after 15 weeks was 0% incidence of organisms commonly associated with BCC. This model of surveillance improved BSI rates, BCC rates, and overall incidence of positive blood isolates. LESSONS LEARNED: Two observed factors facilitated this improvement: enthusiastic unit participation and an automated data-mining surveillance service. The unit staff met weekly to review data and develop actionable plans to consistently maintain compliance. IC's ability to provide timely data updates was essential to reinforce the use of best practices. In addition, it was found that administrative appreciation could be a remarkable resource in the continuous process to promote consistent, high quality patient care.