KEY TAKEAWAYS

Indiana University Health looked at national benchmark data compared to its performance to decide on which healthcare-associated infections to target.

To reduce catheter-associated urinary tract infections, the health system ensured staff were trained on insertion of catheters and daily care for catheters.

Bolstering efforts in staff hand hygiene and hand washing were crucial in reducing the spread of Clostridium difficile and methicillin-resistant Staphylococcus aureus.

Marjorie Rallins, DPM, MS

Executive Director of Health Data Standards

Dr. Marjorie Rallins is a nationally recognized leader in health data standards and informatics. Before joining Regenstrief, she served as vice president and chief scientific officer of the PCPI ® Foundation in Chicago as well as director of clinical informatics for the American Medical Association. Her proven experience in a unique combination of clinical research, business development and thought leadership positions LOINC ® to continue facilitating healthcare interoperability at a crucial time for public health.

Healthcare-associated infection initiatives

To reduce CAUTIs, IU Health has focused on the care bundle for urinary tract catheters, educating staff on the insertion of catheters as well as the daily care for catheters, Weaver says.

"We started with standardizing the insertion kits—making sure that we had the same insertion kits across the health system, with all of the appropriate supplies in an easily used format," Weaver says. "When someone opens a kit, they have everything they need to insert a catheter."

"We put a process in place for non-invasive urinary collection devices that avoided the use of invasive catheters. This effort had a tremendous impact in reducing CAUTI events across the health system," Weaver says. "We make sure we do not use urinary-tract and central-line catheters for the sake of convenience."

Daily chlorhexidine gluconate bathing has helped reduce CLABSI events, according to Weaver, adding patients or families were refusing the bathing, which decreased bathing percentages.

"We changed the language from saying it was a bath to saying it was a treatment, which has been more readily welcomed by the patients and just part of their standard care," Weaver says.

IU Health has strived to be more consistent in its efforts to reduce C. diff infections, Weaver says.

"We have standardized the testing of patients for C. diff. We have made sure patients have a positive indication for C. diff, so we are conducting better stewardship of patients who develop C. diff," Weaver says. "When we have a patient with C. diff, we optimize our isolation of the patient to limit the spread of the infection."

The health system has also bolstered efforts to promote hand hygiene and hand-washing among care team staff, which has helped decrease the spread of C. diff and MRSA, Weaver says.

"We also established a process for isolating patients with MRSA infection to drive those numbers down," Weaver says.

To reduce colon and hysterectomy surgical site infections, IU Health has looked "upstream" to focus on patients who are at high risk for a surgical site infection, Weaver says.

"We made sure patients were optimized before it was time for their surgery to decrease the likelihood of infection," Weaver says. "We evaluated patients who were at high risk for an infection and tried to get their medical issues under control. For example, we made sure we were managing diabetes and were giving nutritional supplements for patients at high risk."

Susan E. Hickman, PhD

Director, Center for Aging Research

Dr. Susan Hickman is a clinical geropsychologist focused on optimizing the quality of life for older adults through improved decision-making and communication about treatment preferences. Much of her work is in advance care planning. She is nationally recognized for her work to help ensure that patients’ end-of-life treatment preferences are known and honored and is a founding member of the National POLST Paradigm. She has spent nearly two decades studying the model’s effects on end-of-life care, and her research findings are used across the country to support programs based on the POLST (Physician Orders for Life-Sustaining Treatment) model.

Marjorie Rallins, DPM, MS