Client Case Study

Infection, Surveillance and Control

About Rochester General Hospital, Rochester, NY
First incorporated in 1847 and now a member of ViaHealth, Rochester General Hospital is a 526-bed, acute care teaching facility. The hospital serves Rochester, the south shore of Lake Ontario and New York's Finger Lakes Region employing more than 4,000 with a medical staff of over 650. Services include inpatient and outpatient care covering a broad range of specialties. Rochester has been named four times as a Solucient 100 Top Cardiovascular Hospital, based on excellent performance and outcomes.

Turning Data into Action and Results
Looking at the data, one area that surfaced as an opportunity for improvement was a serious trend in the rate of nosocomial bloodstream infections in central lines. It was felt that standardization required to safely care for these lines may have been diminished by the fact that staff nurses from all over the organization, who had many other duties, were also responsible for the central lines.

“To see if it would help,” said Linda, “we had the IV team deal exclusively with these catheters in the ICU, and the infection rate was subsequently much lower. We then looked at having the IV team care for these lines throughout the hospital in a very standardized way meeting all the criteria.”

During the budget review process, however, the hospital examined eliminating/reducing the IV team as a cost saving measure. This proposal was refuted with solid data. Based on the average cost of central line bloodstream infections requiring a great deal of resources, along with data showing the significant decrease in the rate of these infections with IV team focus and the cost of the IV team; it was determined that it would be much more cost effective and efficient to keep the IV team intact than to incur costs associated with increased central line infections.

Improvements were made, including the use of the IV team to care for all central lines and the implementation of Chlorohexidine impregnated lines. As a result, infection rates were lowered from 8 per 1,000 line days to 1 per 1000 line days, (CDC benchmark is 5) and this improvement has been maintained. Depending on the severity of the infection, savings ranged from $200,000 to $1.2 million.

Another improvement involved the cardiothoracic department. They had been working on reducing sterna wound infections in diabetics, and then discovered the practices could be more widely applied. Although infrequent, the infections tended to be rather serious when they did occur. In the hospital’s current culture of safety, even one infection is too many—a zero defect rate is the ultimate goal.

The team evaluated the qualitative summaries and then tried to identify what hadn’t yet been done, why infections still occurred and what could be done. They developed a new protocol that included patient education, packs that are given to patients with soap and directions on how to cleanse their wounds. As a result of their projects, the hospital rarely experiences such infections anymore.

“We had one referral that described a near miss when a dialysis bicarbonate alarm was not re-activated by a staff member,” said Linda. “This led us to seek an automated way to ensure re-activation of the alarm setting. One of the engineering staff developed the system and the alarm is now automatically reactivated after five minutes, eliminating the potential for a human error.”