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Audiovisual
Making health care safer: stopping C. difficile infections.
CDC Vital Signs. March 2012:1-4.
This newsletter article and accompanying set of infographics describes strategies to help patients and health care providers prevent health care–associated infections.
Journal Article > Commentary
Antimicrobial stewardship and patient safety.
Zukowski CM. AORN J. 2016;104:354-356.
Antimicrobial stewardship has been highlighted as a strategy to improve antibiotic use in order to reduce hospital-acquired infections. This commentary discusses antimicrobial stewardship teams, their impact in the surgical setting, and the role of nurses in ensuring appropriate use of antibiotics.
Journal Article > Commentary
Incorporating quality and safety values into a CLABSI simulation experience.
Liebrecht CM, Lieb MC. Nurs Forum. 2017;52:118-123.
Simulation has been promoted as a way to teach nurses about potential errors in their practice. This commentary describes the development of a program to help nurses recognize and correct weaknesses in their care processes that increase risk of central line–associated bloodstream infection.
Journal Article > Study
Reductions in sepsis mortality and costs after design and implementation of a nurse-based early recognition and response program.
Jones SL, Ashton CM, Kiehne L, et al. Jt Comm J Qual Patient Saf. 2015;41:483-491.
A protocolized early warning system to improve sepsis recognition and management was associated with a decrease in sepsis-related inpatient mortality. The protocol emphasized early recognition by nurses and escalation of care by a nurse practitioner when indicated. An AHRQ WebM&M commentary describes common errors in the early management of sepsis.
Special or Theme Issue
Infection Prevention.
Allen G, ed. AORN J. 2015;101:505-596.
A primary concern in the perioperative setting is the prevention of health care–associated infections, particularly surgical site infections. Articles in this special issue explore strategies to reduce risk of infection in the perioperative environment, with discussions focusing on human factors principles, instrument sterilization, and specimen management.
Tools/Toolkit > Multi-use Website
ANA CAUTI Prevention Tool.
Silver Spring, MD: American Nurses Association; 2015.
Nurses play an important role in reducing catheter–associated urinary tract infections (CAUTIs). This toolkit, developed as a Partnership for Patients strategy, focuses on promoting nursing behaviors to prevent CAUTIs including decreasing catheter use and improving catheter maintenance.
Book/Report
Patient Safety in Dialysis Access.
Widmer MK, Malik J, eds. Contrib Nephrol. 2015;184:1-270. ISBN: 9783318027051.
Patients with chronic kidney failure are at high risk for adverse events from treatment errors. This publication raises awareness of safety in end-stage renal disease care, explores factors specific to this setting that contribute to failure, and describes techniques for clinicians to reduce risk of errors.
Journal Article > Study
The impact of time at work and time off from work on rule compliance: the case of hand hygiene in health care.
- Classic
Dai H, Milkman KL, Hofmann DA, Staats BR. J Appl Psychol. 2015;100:846-862.
This large observational study demonstrated that hand hygiene compliance rates decrease over the course of a normal work shift. During the first hour of work, average compliance rates were approximately 43%. This dropped to 35% for the last hour of a 12-hour shift. In addition, more intense work shifts were associated with even bigger hand hygiene compliance drop-offs. The authors extrapolate these results to estimate that this compliance decrement could produce an additional 600,000 infections per year in the United States, resulting in up to 35,000 unnecessary deaths and $12.5 billion in excess costs. More time off between shifts led to better compliance rates during a subsequent shift. In this sample, 65% of the caregivers were nurses, and only 4% were physicians. Longer nursing shifts have previously been linked to other patient safety hazards. A prior AHRQ WebM&M commentary discussed challenges related to nursing staffing.
Journal Article > Study
Do clinicians know which of their patients have central venous catheters?: A multicenter observational study.
Chopra V, Govindan S, Kuhn L, et al. Ann Intern Med. 2014;161:562-567.
Catheter-associated infections are common, and largely preventable, adverse events. Though incidence of these events has declined due to intensive safety efforts, one factor contributing to intravenous catheter infections is the failure to remove unnecessary central venous catheters (CVCs). This study sought to determine whether inpatient physicians know which of their patients have CVCs in place by comparing physician response to direct observation of each patient. Physicians were unaware of CVCs in about 20% of the cases examined. Trainee physicians were more likely to be aware of a CVC than teaching attending physicians or hospitalists, and critical care physicians were more likely to know about a CVC than general medicine physicians. These findings suggest that interventions to reduce CVC-associated infections should address clinician awareness of CVCs. An AHRQ WebM&M commentary discusses best practices for removing CVCs.
Journal Article > Study
Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting.
Le-Abuyen S, Ng J, Kim S, et al. Am J Infect Control. 2014;42:439-442.
In this quality improvement study, patients were asked to report on their physician's hand hygiene practice, and mirroring results of prior studies, most patients were willing to participate and rated their physicians highly. Patient reports and nurse observations regarding hand hygiene compliance corresponded 87% of the time, leading the authors to conclude that engaging patients in this role is a feasible method to promote compliance.
Journal Article > Study
Successful implementation of a unit-based quality nurse to reduce central line–associated bloodstream infections.
Thom KA, Li S, Custer M, et al. Am J Infect Control. 2014;42:139-143.
Central line–associated bloodstream infections (CLABSIs) cause substantial morbidity and mortality. Efforts to combat these complications include implementation of checklists and—perhaps more importantly—the enhancement of safety culture. Despite the widespread success of these interventions, some institutions continue to experience CLABSI rates that are above national benchmarks. This study describes the introduction of a unit-based quality nurse dedicated to preventing CLABSIs within a surgical intensive care unit (ICU) at an academic medical center. The quality nurse helped to educate staff about health care–associated infections and prevention strategies. The nurse also provided immediate, direct feedback to staff regarding their compliance with best practices. The average CLABSI rate decreased significantly, even after adjusting for multiple factors including reduction in CLABSI rates in other adult ICUs. A unit-based quality nurse may prove to be a powerful adjunct to the current available tools for reducing these costly infections.
Journal Article > Commentary
Sepsis: recognizing the next event.
Kilburn FL, Bailey P, Price D. Nursing. 2013;43:14-16.
This commentary describes the development and implementation of a standard protocol to help nurses diagnose, assess, and treat sepsis in an emergency department.
Book/Report
Eliminating Catheter-Associated Urinary Tract Infections.
Chicago, IL: Health Research & Educational Trust; July 2013.
This toolkit reveals how to apply strategies from the Comprehensive Unit-based Safety Program to drive reductions in catheter–associated urinary tract infections.
Journal Article > Study
Impact of a team and leaders-directed strategy to improve nurses' adherence to hand hygiene guidelines: a cluster randomised trial.
Huis A, Schoonhoven L, Grol R, Donders R, Hulscher M, van Achterberg T. Int J Nurs Stud. 2013;50:464-474.
In this cluster randomized trial, a strategy that sought to improve nurses' hand hygiene by emphasizing team commitment and leadership engagement did achieve higher hand hygiene rates compared with a standard quality improvement approach. However, the overall rate of hand hygiene adherence remained poor in both groups.
Cases & Commentaries
Preventing PICC Complications: Whose Line Is It?
- Web M&M
Nancy Moureau, BSN, RN, CRNI, CPUI, VA-BC; December 2012
A woman undergoing treatment for myasthenia gravis via PICC developed extensive catheter-related thrombosis, bacteremia, and sepsis, and ultimately died. Although the PICC line was placed at one facility, the patient was receiving treatment at another, raising questions about who had responsibility for the line.
Journal Article > Study
Nurse staffing, burnout, and health care–associated infection.
Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Am J Infect Control. 2012;40:486-490.
The critical role that nurses play in ensuring patient safety can be compromised by excess workload. A large body of literature has linked higher patient-to-nurse ratios to a variety of preventable complications and even increased inpatient mortality. However, it is not clear whether high nursing workload alone can impair patient safety, or if overall working conditions for nurses also plays a role in safety. This study, which examined the association between hospital-acquired infections, nurse staffing, and burnout among nurses found that the number of patients per nurse did not entirely predict safety problems. On the other hand, after controlling for hospital and patient characteristics, the investigators found that increased rates of burnout among nurses was significantly associated with a higher risk of hospital-acquired infections. The complex issue of nurse staffing and workload is discussed in this AHRQ WebM&M commentary.
Book/Report
Preventing Central Line–Associated Bloodstream Infections: a Global Challenge, a Global Perspective.
The Joint Commission. Oakbrook Terrace, IL: Joint Commission Resources; May 2012.
This monograph provides guidance, tools, and techniques for hospitals to help decrease central line–associated bloodstream infections.
Journal Article > Study
Reporting of hazards and near-misses in the ambulatory care setting.
Schnall R, Bakken S. J Nurs Care Qual. 2011;26:328-334.
This study reports on an initiative to encourage student nurses to voluntarily report errors and near misses encountered during ambulatory care rotations.
Journal Article > Study
Tragedy into policy: a quantitative study of nurses' attitudes toward patient advocacy activities.
Black LM. Am J Nurs. 2011;111:26-35.
Unsafe injection practices at an endoscopy clinic in Nevada led to more than 100 patients being infected with Hepatitis C. This survey found that many Nevada nurses felt unwilling to report safety problems due to fear of retaliation—a sentiment reported by those who worked at the clinic in question. The original incident and this survey provided stimulus for the passage of subsequent whistleblower protection legislation.
Journal Article > Commentary
Emerging infections: the contact precautions controversy.
Zastrow RL. Am J Nurs. 2011;111:47-53.
This commentary discusses the risks associated with contact precautions, including anxiety and depression in isolated patients.