Questioning the Culture: The Implementation of Case Reviews to Reduce Hospital Acquired Infections
Topic of Interest
CNS as Project Manager
Quality Initiatives
Capture Value of the CNS
Abstract
Title Questioning the Culture: The Implementation of Case Reviews to Reduce Hospital Acquired Infections
Significance & Background
Hospital acquired Clostridioides difficile (C.diff) infections have had nearly a three-fold increase since 2000, necessitating the implementation of evidence-based practice. Catheter-associated urinary tract infections (CAUTI) are a leading cause of hospital acquired infections (HAI) in adults. The average cost of a hospital acquired CAUTI is $13,793, and C.diff infection is $17,260. At a midwestern academic hospital, an increase in hospital acquired C.diff and CAUTI occurred and were attributed to inappropriate testing. The advanced practice registered nurse (APRN) is uniquely qualified to assist in reducing HAIs because of his or her contribution to system-level change and focus on improved patient outcomes.
Evaluation Methods
After a thorough investigation it was determined a potential cause of these HAIs may have been due to inappropriate testing. The Clinical Nurse Specialist (CNS) team, in collaboration with Infectious Disease and Infection Prevention, developed case review forms with specific evidence-based criteria to ensure cultural stewardship. The case review forms required a comprehensive chart review that warranted the signature of a unit leadership member, in order for the laboratory to commence culturing. A specimen without a case review form was rejected by the laboratory department; this process served as an independent redundancy.
Outcomes
In quarter one of 2019 the CAUTI rate for the organization was 0.83 (per 1,000 patient days), in quarter two the rate was 0.92, in quarter three 1.85, then a decline in quarter four to 0.46, then to a low of 0 in 2020 quarter one. In quarter one of 2019 the C. diff infection rate for the organization was 3.26 (per 10,000 patient days). The rates showed a decrease and stabilization in quarter two to 0.52, in quarter three to 0.52, and quarter four to 0.53, and 0.55 in quarter one of 2020.
Implications
This evidence-based practice process will mitigate unnecessary antibiotic administration therefore reducing antibiotic resistance, and lead to improved overall patient outcomes. The educational preparation of an APRN affords them the ability to critically appraise evidence thus being able to implement evidence-based practice. Addressing cultural stewardship is paramount in mitigating inappropriate antibiotic administration attributing to antibiotic resistance, increased length of stay and costs. Decreasing HAIs will lead to a cost reduction for the hospital which is key to financial vitality.