Reducing Three Infections Across Cardiac Surgery Programs: A Multisite Cross-Unit Collaboration.

Area of Science:

• Healthcare quality improvement
• Patient safety
• Infection prevention

Background:

• Healthcare-associated infections (HAIs) and patient safety culture are critical concerns in cardiac surgery.
• Multifaceted interventions are often employed to address these complex issues simultaneously.

Purpose of the Study:

• To evaluate the impact of a comprehensive program on three specific HAIs and patient safety culture in cardiac surgery.
• To assess the effectiveness of the Comprehensive Unit-based Safety Program (CUSP) and evidence-based bundles.

Main Methods:

• A pre-post design was utilized across 11 hospitals within the cardiac surgery service line.
• Interventions included CUSP for safety culture and bundles for central line-associated bloodstream infection (CLABSI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP) prevention.
• Data were collected over three years to track infection rates and patient safety culture domains.

Main Results:

• CLABSI and SSI rates initially decreased but returned to baseline levels by the third year.
• Ventilator-associated pneumonia (VAP) rate changes were confounded by a definition modification.
• Significant improvement was noted in 'hospital management support,' but 'feedback and communication about errors' and 'staffing' domains declined.

Conclusions:

• Simultaneous implementation of multiple interventions across diverse units presents significant challenges.
• Sustainment of improvements requires dedicated and ongoing efforts.
• Future research should anticipate both positive and negative shifts in various patient safety culture dimensions.