Edward Septimus1, Jason Hickok2, Julia Moody2, Ken Kleinman3, Taliser R Avery3, Susan S Huang4, Richard Platt3, Jonathan Perlin2. 1. Hospital Corporation of America, Nashville, Tennessee Texas A&M Health Science Center College of Medicine, Houston. 2. Hospital Corporation of America, Nashville, Tennessee. 3. Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts. 4. University of California, Irvine Health School of Medicine.
Abstract
BACKGROUND: Challenges exist in implementing evidence-based strategies, reaching high compliance, and achieving desired outcomes. The rapid adoption of a publicly available toolkit featuring routine universal decolonization of intensive care unit (ICU) patients may affect catheter-related bloodstream infections. METHODS: Implementation of universal decolonization-treatment of all ICU patients with chlorhexidine bathing and nasal mupirocin-used a prerelease version of a publicly available toolkit. Implementation in 136 adult ICUs in 95 acute care hospitals across the United States was supported by planning and deployment tactics coordinated by a central infection prevention team using toolkit resources, along with coaching calls and engagement of key stakeholders. Operational and process measures derived from a common electronic health record system provided real-time feedback about performance. Healthcare-associated central line-associated bloodstream infections (CLABSIs), using National Healthcare Safety Network surveillance definitions and comparing the preimplementation period of January 2011 through December 2012 to the postimplementation period of July 2013 through February 2014, were assessed via a Poisson generalized linear mixed model regression for CLABSI events. RESULTS: Implementation of universal decolonization was completed within 6 months. The estimated rate of CLABSI decreased by 23.5% (95% confidence interval, 9.8%-35.1%; P = .001). There was no evidence of a trend over time in either the pre- or postimplementation period. Adjusting for seasonality and number of beds did not materially affect these results. CONCLUSIONS: Dissemination of universal decolonization of ICU patients was accomplished quickly in a large community health system and was associated with declines in CLABSI consistent with published clinical trial findings.
BACKGROUND: Challenges exist in implementing evidence-based strategies, reaching high compliance, and achieving desired outcomes. The rapid adoption of a publicly available toolkit featuring routine universal decolonization of intensive care unit (ICU) patients may affect catheter-related bloodstream infections. METHODS: Implementation of universal decolonization-treatment of all ICU patients with chlorhexidine bathing and nasal mupirocin-used a prerelease version of a publicly available toolkit. Implementation in 136 adult ICUs in 95 acute care hospitals across the United States was supported by planning and deployment tactics coordinated by a central infection prevention team using toolkit resources, along with coaching calls and engagement of key stakeholders. Operational and process measures derived from a common electronic health record system provided real-time feedback about performance. Healthcare-associated central line-associated bloodstream infections (CLABSIs), using National Healthcare Safety Network surveillance definitions and comparing the preimplementation period of January 2011 through December 2012 to the postimplementation period of July 2013 through February 2014, were assessed via a Poisson generalized linear mixed model regression for CLABSI events. RESULTS: Implementation of universal decolonization was completed within 6 months. The estimated rate of CLABSI decreased by 23.5% (95% confidence interval, 9.8%-35.1%; P = .001). There was no evidence of a trend over time in either the pre- or postimplementation period. Adjusting for seasonality and number of beds did not materially affect these results. CONCLUSIONS: Dissemination of universal decolonization of ICU patients was accomplished quickly in a large community health system and was associated with declines in CLABSI consistent with published clinical trial findings.
Authors: Jason P Burnham; Elvin Geng; Chinmayi Venkatram; Graham A Colditz; Virginia R McKay Journal: Clin Infect Dis Date: 2020-06-24 Impact factor: 9.079
Authors: Susan S Huang; Edward Septimus; Ken Kleinman; Julia Moody; Jason Hickok; Lauren Heim; Adrijana Gombosev; Taliser R Avery; Katherine Haffenreffer; Lauren Shimelman; Mary K Hayden; Robert A Weinstein; Caren Spencer-Smith; Rebecca E Kaganov; Michael V Murphy; Tyler Forehand; Julie Lankiewicz; Micaela H Coady; Lena Portillo; Jalpa Sarup-Patel; John A Jernigan; Jonathan B Perlin; Richard Platt Journal: Lancet Date: 2019-03-05 Impact factor: 79.321
Authors: Chanu Rhee; Rui Wang; Yue Song; Zilu Zhang; Sameer S Kadri; Edward J Septimus; David Fram; Robert Jin; Russell E Poland; Jason Hickok; Kenneth Sands; Michael Klompas Journal: Crit Care Explor Date: 2019-10-14
Authors: Isomi Miake-Lye; Selene Mak; Christine A Lam; Anne C Lambert-Kerzner; Deborah Delevan; Tanya Olmos-Ochoa; Paul Shekelle Journal: J Gen Intern Med Date: 2020-10-27 Impact factor: 5.128