Zero Hospital-Acquired Infections? Believe It.

Convincing clinicians that getting to zero infections is possible, says one CQO. It requires a culture change, adherence to evidence-based practice, and leadership.

Danielle Scheurer, MD, believes that the plague of hospital-acquired infections and other patient harm is within clinicians' power to cure. Infections, no matter how small the ratio to the number of surgical interventions, are not simply part and parcel of surgery, she contends.

If that belief does not permeate among clinicians involved in surgery, it's tough to make headway on the national scourge of avoidable patient harm—a reality made frighteningly mainstream with the publication of the report, To Err Is Human, by the Institute of Medicine, way back in 1999.

Convincing is Half the Battle

Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina, where she is also an associate professor of medicine.

She says big progress can be made in infection control, especially where surgery is concerned, from convincing clinicians that getting to zero infections is possible.

"I'm not sure a lot of people even believed that was true as short as 10 years ago," she says.

But now, there is at least proof of concept that if evidence-based practices are applied consistently, it is possible to achieve zero harm—or come extraordinarily close.

Among others, both Memorial Hermann and Cincinnati Children's hospitals have both proven that near-zero harm is possible, but to achieve those results, the board and clinicians had to believe it was possible.

"Before you do anything else, make sure your care team members believe that's true," says Scheurer. "You can't get rigorous practice without variability until everyone believes."

On its face, that's a strange concept—the idea that belief is a critical component of something being possible. But belief presages action, and action is certainly critical to limiting harm, from infection to surgical site errors—to near zero levels.

Dashboards, Champions

There are many ways to convince clinicians to believe in zero harm, says Scheurer.

At MUSC, they started by studying other healthcare organizations—such as Memorial Hermann or Cincinnati Children's—where buy-in went well beyond bedside care and the OR—to frontline workers, the administration, and even board members.

Scheurer started by identifying high performing teams within her organization. At MUSC, one such team is in the pediatric cardiac ICU, which cares for some of the sickest, most vulnerable patients.

Patients go there there for complex cardiac surgeries, and they're already in a weakened state when they arrive. Prior to surgery, they're often in the ICU, and they often have, as Scheurer says, "a half-dozen portals of entry into their bodies—pacing wires, catheters, and central lines."

"That team sort of just accepted as their mental model that 'we're here to save the baby's life, there will be some infections, but that's just the risky business we're in,'" Scheurer says.

"I'm not sure anyone on that team believed zero harm was possible."

But working diligently on compliance with a dashboard of known infection-reduction techniques, including building a culture of safety and reducing the time, even to the hour, that infection pathways are in the patient's body, yielded payoffs that drastically changed that attitude.

"Some of our ICUs have gone up to two years [without an infection] as risk factors have been reduced," Scheurer says. "Those are the best evangelists for other teams."

She says that a single champion who can vouch for a proof of concept in a complex area makes culture change easier.

Her husband is a cardiac pediatric intensivist who once argued with Scheurer that eliminating infections in such settings was not possible. Thanks in part to the results in the pediatric cardiac ICU, "he has totally come around," she says.

Chipping Away at Barriers

With infections, there's often no way to prove when or where the inoculation occurred, which is one reason adherence to a bundle of evidence-based procedures is so important.