Reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens.

BACKGROUND: The purpose of this study was to determine the effectiveness of copper-impregnated composite hard surfaces and linens in an acute care hospital to reduce health care-associated infections (HAIs). METHODS: We performed a quasiexperimental study with a control group, assessing development of HAIs due to multidrug resistant organisms (MDROs) and Clostridium difficile in the acute care units of a community hospital following the replacement of a 1970s-era clinical wing with a new wing outfitted with copper-impregnated composite hard surfaces and linens. RESULTS: The study was conducted over a 25.5-month time period that included a 3.5-month washout period. HAI rates obtained from the copper-containing new hospital wing (14,479 patient-days; 72 beds) and the unmodified hospital wing (19,177 patient-days) were compared with those from the baseline period (46,391 patient-days). The new wing had 78% (P = .023) fewer HAIs due to MDROs or C difficile, 83% (P = .048) fewer cases of C difficile infection, and 68% (P = .252) fewer infections due to MDROs relative to the baseline period. No changes in rates of HAI were observed in the unmodified hospital wing. CONCLUSIONS: Copper-impregnated composite hard surfaces and linens may be useful technologies to prevent HAIs in acute care hospital settings. Additional studies are needed to determine whether reduced HAIs can be attributed to the use of copper-containing antimicrobial hard and soft surfaces.

Building and sustaining a systemwide culture of safety.

BACKGROUND: In 2002, Sentara launched a systemwide initiative to significantly reduce events of harm to patients and employees. The initiative began at Sentara Norfolk General Hospital. Since then, the safety principles piloted there have been instituted throughout Sentara's integrated health care system of hospitals, nursing homes, and physician practices. ACCELERATING THE PACE OF IMPROVEMENT: Implementation at each local site begins with a thorough assessment of its safety culture. Four core areas of focus include (1) establishing safety as a core value, (2) creating Behavior-Based Expectations (BBEs) for error prevention that are tailored for staff, leaders, and physicians, (3) developing a state-of-the-art root and common-cause analysis program, and (4) implementing an approach to focus and simplify work processes and procedure documentation. KEYS TO SUCCESS: Senior leadership demonstrated a commitment to making safety a core value by embedding safety into strategic priorities, incentives, rewards and recognition, and human resources policies and procedures; prioritization of operational goals to ensure the availability of time and resources to make the safety initiative the key focus; involvement of employees and medical staff each step of the way; establishment of site-based safety initiative teams of operational leaders with the responsibility for leading the safety initiative implementation and ensuring effective communication across the organization; and a willingness to learn and try successful techniques from high-reliability organizations outside health care.

Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing.

OBJECTIVE: To examine whether a supplemental remote intensive care unit (ICU) care program, implemented by an integrated delivery network using a commercial telemedicine and information technology system, can improve clinical and economic performance across multiple ICUs. DESIGN: Before-and-after trial to assess the effect of adding the supplemental remote ICU telemedicine program. SETTING: Two adult ICUs of a large tertiary care hospital. PATIENTS: A total of 2,140 patients receiving ICU care between 1999 and 2001. INTERVENTIONS: The remote care program used intensivists and physician extenders to provide supplemental monitoring and management of ICU patients for 19 hrs/day (noon to 7 am) from a centralized, off-site facility (eICU). Supporting software, including electronic data display, physician note- and order-writing applications, and a computer-based decision-support tool, were available both in the ICU and at the remote site. Clinical and economic performance during 6 months of the remote intensivist program was compared with performance before the intervention. MEASUREMENTS AND MAIN RESULTS: Hospital mortality for ICU patients was lower during the period of remote ICU care (9.4% vs. 12.9%; relative risk, 0.73; 95% confidence interval [CI], 0.55-0.95), and ICU length of stay was shorter (3.63 days [95% CI, 3.21-4.04] vs. 4.35 days [95% CI, 3.93-4.78]). Lower variable costs per case and higher hospital revenues (from increased case volumes) generated financial benefits in excess of program costs. CONCLUSIONS: The addition of a supplemental, telemedicine-based, remote intensivist program was associated with improved clinical outcomes and hospital financial performance. The magnitude of the improvements was similar to those reported in studies examining the impact of implementing on-site dedicated intensivist staffing models; however, factors other than the introduction of off-site intensivist staffing may have contributed to the observed results, including the introduction of computer-based tools and the increased focus on ICU performance. Although further studies are needed, the apparent success of this on-going multiple-site program, implemented with commercially available equipment, suggests that telemedicine may provide a means for hospitals to achieve quality improvements associated with intensivist care using fewer intensivists.