Arkansas hospitals are hoping to replicate the success of a program that reduced catheter-related bloodstream infections in many Michigan hospitals to zero within three months of its implementation there.

 

Arkansas was one of 28 states selected to work with the Stop BSI project, a national effort led by Peter Pronovost, MD, a Michigan intensive care physician and a professor of anesthesia and critical care at Johns Hopkins University. According to Stop BSI, 30,000 to 62,000 people die each year from catheter-related bloodstream infections in the United States.

 

Pronovost started the movement at Johns Hopkins when he decided that the prevailing attitude that such infections were inevitable wasn't consistent with the evidence that showed that they weren't. After the hospital was able to eliminate almost all infections, the Michigan Health & Hospital Association made it a statewide effort. Within three months of the project's inception, the statewide median infection rate had dropped from 2.7 per 1,000 catheter days to almost zero, while the mean rate was about one per thousand catheter days. The reduced infections saved an estimated 1,500 lives and $200 million in patient costs in 18 months. "This program works, and it works rapidly," Pronovost said in an interview.

 

In recognition of his efforts, Pronovost was named by Time magazine to the Time 100 list of the world's most influential people in 2008.

 

The initiative went national when it received about $3 million in grants from the Agency for Healthcare Research and Quality, the Sandler Family Supporting Foundation, and an anonymous donor. The project's Web site is www.safercare.net.

 

The Arkansas Hospital Association is leading Arkansas' two-year project, which has attracted the involvement of 34 hospitals. (Some other hospitals are involved in similar initiatives.) The Arkansas Foundation for Medical Care is supporting the project with a grant of up to $5,000 to offset the costs.

 

The project began with eight conference calls and continued with a meeting of hospital representatives in Little Rock, August 27, with Pronovost the featured presenter. Follow-up calls between participants and Johns Hopkins will continue throughout the life of the project.

 

During the Little Rock meeting, Pronovost compared and contrasted efforts against hospital infections to the fight against polio, which has largely been defeated worldwide thanks to an army of dedicated health professionals. Unfortunately, little has been done in the United States about hospital infections despite the well-known seriousness of the problem. "We believe this is … our polio campaign for the 21st century," he said.

 

Pronovost stressed that while standards should be determined nationally, programs and policies should be created at the state and particularly the hospital levels, with teams leading and innovating according to the local context.

 

Provonost's process involves implementing checklists to ensure proper hygiene is followed. But to make those checklists work, the staff has to buy into the change. That is accomplished in part through what he called the Comprehensive Unit-based Safety Program, or CUSP. The five-part process involves educating the staff; identifying defects such as work processes that contribute to higher infection rates; involvement by hospital executives; learning from mistakes; and implementing teamwork tools. Involving the staff is critical so they will feel engaged in the process, he said.

 

Changing a hospital's culture can be challenging because it involves changing attitudes, beliefs and behaviors, he said. Office politics and egos can get in the way of successful implementation, an idea that was reinforced when several nurses in the audience said they had been rebuffed when they reminded a surgeon to engage in proper hygiene practices. Pronovost said that team leaders must recognize that most medical professionals want to do everything they can to help patients, but that they can feel threatened when their habits are questioned. "That is the hardest part of the work, why it dies on the vine, are these adaptive problems," he said.

 

Pronovost said he doesn't believe that people fear change. After all, he said, no one would refuse a winning lottery ticket even though it would change their life. What they fear, he said, is loss – in the case of new hygiene practices, a loss of esteem or identity. That's why leadership teams must create communication processes that address those worries and that frame the issue in terms of what is best for the patients.