Becker's Clinical Quality & Infection Control

14 Executive Briefing SPONSORED BY C ornerstone Specialty Hospitals Little Rock (Ark.) faced a crisis. In 2019, the rate of hospital-acquired infections significantly exceeded the hospital's own targets and national benchmarks. Dissatisfied with these results, Cornerstone focused on the causes of these HAIs, formed a team to improve the hospital's results, developed a Model for Enhancement, Advancement and Improvement and implemented multiple changes — which produced significant results. To learn how Cornerstone Specialty Hospitals Little Rock lowered HAI rates, Becker's Hospital Review recently spoke with two Cornerstone clinical leaders: Kiacie Farmer, BSN, RN, chief nursing officer; and Toi Grimm, RN, director of quality management. They described this hospital's disappointing HAI results in 2019 and the steps taken to transform the environment and decrease HAIs in 2020 and 2021. Falling short of targets and benchmarks Cornerstone in Little Rock is a 30-bed long-term acute care unit comprising 19 high-observation beds and 11 mixed medical- surgical beds. The Little Rock facility is one of 18 Cornerstone Specialty Hospitals. Ms. Farmer characterized 2019 as "a pretty rough year with hospital-acquired infections." The hospital had 12 catheter- associated urinary tract infections, resulting in a CAUTI rate of 2.75 against a target of 1.0 and a national benchmark of 2.0. Cornerstone in Little Rock also had five central line-associated bloodstream infections, resulting in a CLABSI rate of 1.21, compared to a target of 1.0 and a national benchmark of 1.0. The low point came in September of 2019 when this hospital had four CAUTIs in one month, causing the hospital's leaders to conclude that changes were essential. Understanding the reasons why Before deciding on changes, Cornerstone shared the hospital's HAI data with the staff and formed a team to focus on reducing HAIs. This team first focused on understanding the reasons why the hospital's HAIs were so high. Team members spoke with and listened to staff and conducted a deep dive on the HAIs. This team found Cornerstone lacked standard practices. "We did not have good, standard processes for the staff," Ms. Grimm said. Everyone was kind of doing their own thing." For example, some staff members were using chlorhexidine gluconate when giving baths, and other staff members saw use of CHG as optional. When CHG was used, it was used inconsistently, with some staff members using a few drops and others using half a bottle. Ms. Grimm reported that some staff members told her, "Well, it just depends on the patient." The team also found many infections were related to using diapers and to catheters remaining inserted longer than necessary. Creating consistent standards Cornerstone Specialty Hospitals Little Rock set a goal of creating a culture of patient safety by developing and implementing standard practices. It termed its efforts the Model for Enhancement, Advancement and Improvement to Lower HAIs. These practices included adopting guidelines the Agency for Healthcare Research and Quality for line care and eliminating the use of diapers. Standards were created for weekly dressing changes and for tubing changes. Cornerstone also decided to replace patient baths using soap and water with baths using 4 percent CHG. Cornerstone developed specific guidelines for the use of CHG as part of baths. The guidelines specified: • Use foam pump to place CHG directly onto the skin • Use wet wash cloths to spread the CHG • Use a different wet wash cloth to rinse • Do not dilute • The liquid CHG should no longer be in use • One foam bottle should last three to five baths "It wasn't a guessing game anymore," Ms. Farmer said. "Standardizing the process as well as the product became a secondary goal." Driving and sustaining organizational change Developing consistent guidelines and practices was the first step, but the key to success was having those practices implemented and sustained on an ongoing basis. The most important elements of driving change at Cornerstone were: How Cornerstone Specialty Hospitals reduced HAIs by changing its processes and culture

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