Every year in the United States, an estimated 80,000 patients with central catheters will develop bloodstream infections, and some 31,000 will die from them. The costs of treating these avoidable complications may be as high as $3 billion.
For generations, health care providers considered bloodstream infections an unavoidable byproduct of care. However, it was clear that providers did not consistently follow simple evidence-based guidelines for preventing these infections and did not have a culture that allowed nurses to speak up when something wasn’t right.
At Johns Hopkins, we introduced a low-tech, low-resource program that increased adherence to evidence-based practice while improving teamwork and the workplace safety culture. This program produced drastic reductions in central line-associated bloodstream infections.
The program’s elements include:
- Identifying five simple steps known to prevent bloodstream infections—such as hand-washing before line insertion and avoiding line placement in the groin area—and incorporating them into a checklist similar to those used by aviation crews.
- Developing central-line insertion “bundles” that contain all supplies and sterile material needed for the procedure. This simplifies the procedure and ensures that all items are readily available.
- Encouraging nurses to speak up, and even stop the procedure, if providers deviate from the guidelines
- Training staff in the science of safety, as part of the comprehensive unit-based safety program (CUSP).
- Fostering the development of a workplace culture of safety in which caregivers feel welcome to bring up concerns—such as when a physician attempts to insert a line without first washing hands—and their ideas for how to prevent harm.
- Ongoing measurement and feedback of infection rates to staff and managers.
Our Track Record
The program was transformative. Infection rates in many ICUs dropped 90 percent over 18 months, and since then several ICUs have gone a year or two without a single bloodstream infection.
After proving successful in The Johns Hopkins Hospital, this program was rolled out in ICUs across the state of Michigan, an effort that was found to have reduced deaths by 10 percent. In recent years, the Johns Hopkins model is being rolled out state-by-state across the country, and it has also been embraced in dozens of other countries.
How We Can Help
As one of the architects for this bloodstream infection program, the Center for Innovation has a long track record of helping clinical units to adopt these measures and achieve similar results. We realize that improving the quality of care involves more than handing someone a checklist and telling them to use it. Our programs focus on bringing together the leadership support and culture change that are required for caregivers to change their behavior.