It is estimated that every year in the United States, 250,000 patients contract a blood stream infection from a central line, and between 12 and 25 percent die needlessly because of them. Takoma Regional Hospital took part in an 18-month study with Johns Hopkins University and 35 other intensive care units in the Adventist Health System, headquartered in Winter Park, Florida, and Adventist Health, headquartered in Roseville, California, to not only reduce fatalities from central line acquired blood stream infections, but to eliminate them completely.
The results were astounding. In February Takoma Regional’s intensive care unit celebrated going 24 months without having such an infection and they were recognized for being one of 15 intensive care units in the study to have gone more than a year without a central line acquired blood stream infection.
When the study began in March 2007, the national rate for central line acquired blood stream infections was 3.21 per 1,000 line days and Adventist Health System’s average rate was 2.77 per 1,000 line days. When the study ended last September, the overall rating for the hospitals participating in the study was 0.61 per 1,000 line days with the average blood stream infection rate median of zero.
“For decades, patients have contracted infections from central lines, and evidence based medicine developed by Johns Hopkins University has made all the difference,” says Bernadette Keys, director of Takoma Regional’s intensive care unit who also has 30 years of experience in the field.
Keys says this project has been groundbreaking for Johns Hopkins, and because of the work and results from the study, the United States Congress has asked Johns Hopkins to work with 10 states, including Tennessee, to implement these new procedures. In fact Takoma Regional’s intensive care unit is one of only a few intensive care units in the state maintaining a zero rate for central line acquired blood stream infections
Keys says the key initiatives from the study were the implementation of specific techniques and tools in regards to inserting, caring for and removing central lines as well as maintaining communications with the entire team.
As part of the study, Takoma Regional and the other hospitals had to complete a Safety Attitude Questionnaire. Johns Hopkins University found that disruptive behavior and poor communication leads to turnover, which negatively affects outcomes and length of stay. In its findings from the study, Johns Hopkins University reports that nursing turnover has decreased, which is attributed to the enhanced level of communication as part of the communication tools for staff and physicians.
Keys says that although it sounds simple, the study found that the care plan must be verbalized. “If you express it, everyone knows what your goal is,” says Keys. “When we communicate well, everyone is on the same page. We’re trying to prevent the least amount of germs, and to do that, we have to develop open communication as part of the care plan.”
When they do have an infection, Keys says they have procedures to investigate.
“Our mean rate has been zero for a while, and if we have infections, we have protocols for a full-fledge investigation which has helped us determine what caused the infection,” says Keys.
“Takoma did exceptionally well and we’re very proud of these results,” says Janet Jacobs, corporate patient safety officer with Adventist Health System. “The results and increased communications are improving care for all people.”