Peter Pronovost, M.D., thinks that health care might be at its man-on-the-moon moment. The famed Johns Hopkins Medicine physician, researcher and patient safety guru made the assertion during a press conference yesterday where he joined AHRQ's Carolyn Clancy, the AHA's Rich Umbdenstock and two other clinicians to announce the dramatic results of a program aimed at reducing health care-associated infections.
The Comprehensive Unit-based Safety Program, a joint effort between the AHA's Health Research & Education Trust, Johns Hopkins and AHRQ, set out to build off of the success Pronovost had in the early 2000s working with the Michigan Health & Hospital Association to reduce infections in more than 100 ICUs across the state. During the past four years, more than 1,100 adult ICUs participated in CUSP and saw a 40 percent drop in central line-associated bloodstream infections. That meant CLABSIs were prevented in more than 2,000 patients, 500 lives were saved and there was a cost avoidance of $34 million, Clancy said.
"This could be health care's man-on-the-moon moment," Pronovost said, referencing JFK's 1961 declaration that America would literally shoot for the stars. "With these results, health care is taking a giant step forward."
CUSP is a multi-pronged approach that embraces evidence-based interventions, such as removing unnecessary central lines and ensuring proper hand hygiene; a culture change that encourages team work and empowers front-line staff to be equal partners with physicians when it comes to enhancing patient safety; and measuring results and providing constant feedback to the teams. Along with releasing the results, AHRQ made public a toolkit to help hospitals implement CUSP.
Just as important, it changes the mindset among clinicians — and hospital leaders — that HAIs are a routine part of doing business.
"Like many other systems, we were operating under the assumption that infections like these were an inevitable part of being sick and being in the hospital," Michael Tooke, M.D., chief medical officer of Shore Health, a two-hospital system in eastern Maryland said during the press briefing. "We knew that our infection control professionals were doing the best they could, and that the increases in infection rates we saw were, frankly, the cost of being sick. But then something startling happened. There was this guy at Hopkins who was trying to get control of their infections, and he was using these simple-minded checklists, and he was telling everyone in his unit they were all responsible for infections, and then, in what I believe was a surprise even to him, they quit having central line infections. They didn't just reduce the number, they eliminated them."
Tooke rattled some impressive stats of his own: 810 days (and counting) since the last CLABSI at Memorial Hospital and 1,025 days (and counting) at Dorchester General. No ventilator-associated pneumonia in either ICU since February 2010. And, 1,245 (and counting) without a central line urinary tract infection at the system's 20-bed rehab unit.
After implementing CUSP in its ICU, Peterson Regional Medical Center, has eliminated CLABIs, said Theresa Hickman, R.N., nurse educator, at the 124-bed hospital in Kerrville, Texas. She said CUSP is the "most powerful program" she's seen in her 32 years as a nurse.
Both Hickman and Tooke said it is important to continually feed data back to staff and to celebrate achievements. Once staff see how they can dramatically improve patient safety, they want to keep driving toward zero.
"Success is like rocket fuel," Tooke said.