Becker's Clinical Quality & Infection Control

13 Sign up for the Free Becker's Infection Control and Clinical Quality E-Weekly at www.beckersasc.com/clinicalquality. The news was a bolt out of the blue because my previous team, up until December 2010, wasn't giv- ing me accurate data about our infection problems. I knew that something dramatic had to be done. I couldn't stomach the thought of harming patients, not to mention rousing the ire of my Sicilian mother. Target zero To enact meaningful change, I needed to under- stand what was being done, and what was not, to prevent and control the spread of infection in my hospital. I asked the directors of infectious disease, quality and nursing to develop both an assessment to measure infection and a plan to combat our un- acceptable rate of CLABSI and other infections. Over the course of a near-sleepless month, I worked very closely with the medical executive committee and the infection preventionists to come up with a path forward that would reverse this problem. To start with, the heads of quality, nursing and infection control visited every patient twice daily, giving me daily reports on their current condi- tion, with a focus on any possible or confirmed infections. To this day, I get a report every Friday with this summary. If we see that a unit is slipping or a certain cohort of patients is regressing, we hold court and identify a solution to the problem. On top of this comprehensive patient monitor- ing program, we launched a robust hand hygiene campaign to identify those who were not comply- ing. Everyone was held accountable. Campaign tactics included buttons and posters that encouraged patients to "Ask If I've Washed My Hands." We had "secret shoppers" deployed throughout the hospital to report on doctors and others who were reluctant hand washers. Initially, I heard a lot of excuses. But, there was no compromise, no matter how busy they were, or what station in life they had attained. Infec- tion control was and is an organizational priority, and I was willing to do whatever was necessary to improve the quality of healthcare we were pro- viding. My job was to convince hospital staff that preventing potentially deadly infections was the right thing to do. Lessons learned The road to success was by no means easy, but we learned a lot along the way: 1. Don't expect — inspect. Sometimes you can't take what's being fed to you at face value. If you dig beneath the surface, you might find some things that need to be changed. 2. The buck stops with the CEO. In order to make infection prevention an organizational priority, the boss has to be the driver. Leaders need to be visible to staff, showing hands-on commitment, talking the talk and walking the walk. Besides just talking about the process in order to be the role model, I was the first to receive the flu shot, kick- ing off the hospital flu shot campaign. 3. Transparency can be frightening, but it should also be embraced. Organizations are forced to look at themselves and create benchmarks. Trans- parency can bring about necessary change. 4. Having a targeted mission can build a sense of community. Bringing all parties — healthcare personnel, medical staff, patients and administra- tion — together to achieve a common goal can encourage community building. 5. Educate the staff; do not hide the problem. Once the problems are exposed, staff members are better able to internalize, own and correct the situation. 6. Recognition is critical to success. To keep them motivated, it is important that leaders, physicians and hospital staff are credited for the work they have performed. 7. When the goal is met, don't stop. Continue to provide incremental goals. Provide ongoing edu- cation and continue to celebrate your success. 8. Improvement in one area can cause waves of improvement in other areas. Making it your mis- sion to improve one quality area can improve oth- er quality areas, such as reducing readmissions. In our case, when we reduced infections, our patient satisfaction scores improved dramatically. Success can be achieved We hit our goal of zero HAIs in six months. Today we are nearly running at zero for all targeted in- fections, including CLABSI and methicillin-resis- tant Staphylococcus aureus. That means we've had no CLABSIs in the past four months and no cases of MRSA since January 2013. With my team's help, we were able to make infection prevention a part of the DNA of Olympia Medical Center. Now I know that my mother would be safe in my hospital. Can you say the same about yours? n John Calderone, PhD, CEO at Olympia Medical Center in Los Angeles, Ca., received the 2013 Health- care Administrator Award from the Association for Professionals in Infection Control and Epidemiology. How a No-Nonsense Hospital CEO Reached the Target of Zero Infections (continued from cover) A recent study in Ontario, Canada, found surgical safety checklists may not be as effective in improving quality outcomes as previously believed, according to research published in New England Journal of Medicine. Researchers compared clinical quality data from 101 acute-care hospitals that implemented any surgical safety checklist between June 2008 and September 2010. They found the 30-day surgical mortality rate was 0.71 percent three months before checklist implementation and 0.65 percent three months after imple- mentation, not a statistically significance difference. The risk of surgical com- plications was 3.86 percent before implementation and 3.82 percent after. In 2010, Canada's Ministry of Health and Long-Term Care mandated that hospitals adhere to surgical safety checklists, but they did not require formal training of proper checklist adherence, according to a Medscape report dis- cussing the study. Lucian Leape, MD, professor at the Harvard School of Public Health, wrote an accompanying editorial to the study, also published in NEJM, and said, "it is not the act of ticking off a checklist that reduces complications, but perfor- mance of the actions it calls for," according to the Medscape report, suggest- ing proper implementation and use requires more in-depth interaction with the checklist instead of simply running through tasks. Dr. Leape said fully implementing a checklist requires certain resources and expertise, investment in adherence by all clinical staff and adaptation to in- dividual needs. n Proper Training Necessary for Effective Surgical Safety Checklist use By Akanksha Jayanthi John Calderone

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