How IU Health Cut Healthcare-Associated Infections by 50%

The health system has focused on catheter-associated urinary tract infection, central line-associated bloodstream infection, Clostridium difficile, methicillin-resistant Staphylococcus aureus, and colon and hysterectomy surgical site infections.

Indiana University Health (IU Health) has significantly reduced healthcare-associated infections through a series of initiatives over the past six years.

On a daily basis, 1 in 31 of hospitalized patients in the United States has at least one healthcare-associated infection, according to the Centers for Disease Control and Prevention. Healthcare-associated infections have several negative impacts, including increased length of stay, hospital readmissions, and morbidity and mortality.

Healthcare-associated infections are a key element of patient safety, which is a top concern for CMOs. Health system and hospital CMOs can learn from IU Health's success in reducing healthcare-associated infections.

Over the past six years, IU Health has focused on several healthcare-associated infections: catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), Clostridium difficile (C. diff), methicillin-resistant Staphylococcus aureus (MRSA), and colon and hysterectomy surgical site infections.

Efforts to reduce these healthcare-associated infections at the health system have decreased these patient harms by nearly 50%, says Christopher Weaver, MD, MBA, senior vice president and chief clinical officer at IU Health.

"In 2017, we had more than 700 of these events. In 2023, we had 382 of these events," Weaver says.

According to Weaver, data and standardization have played key roles in IU Health's healthcare-associated infection initiatives.

"We have focused on good, clean, timely, and actionable data both in outcomes and processes. We have looked at data that shows how we are performing in care bundles," Weaver says. "We have also looked at our standardization of processes and supplies."

National benchmark data indicated IU Health could improve its healthcare-associated infection performance, Weaver explains.

"We looked at national benchmarks for these infections that gave us good data and recognition about the harm that these infections cause," Weaver says. "We were not performing at the level where we wanted to perform."

Christopher Weaver, MD, MBA, is senior vice president and chief clinical officer at IU Health. Photo courtesy of IU 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."

For CAUTIs as well as CLABSIs, the health system has tried to limit the use of catheters whenever medically appropriate.

"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."

The health system also made sure clinical staff were following care bundles for preoperative care, intraoperative care, and postoperative care. In addition, clinical staff focused on daily care of wounds after surgery, Weaver says.

Implementation tips

Weaver explains there is no "special trick" for avoiding these infections to take care of the problem and drive infection rates to near zero.

"In reality, much of the work involves conducting the basics of care and making sure all of our team members understand the importance of infection prevention," Weaver says.

As IU Health posted gains in some of its healthcare-associated infections, it was crucial to maintain those improvements before moving on to other initiatives, Weaver says.

"We were able to improve our performance on CAUTI, CLABSI, and C. diff, and it was important to keep that data in front of us to stay at an optimal level of performance," Weaver says. "Then we shifted our focus to more infections such as MRSA and colon and hysterectomy surgical site infections."