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Tools for the Real-Time Assessment of a Pseudomonas aeruginosa Infection Model
Published on: April 6, 2021
Pseudomonas infection reduction in the ICU: a successful multidisciplinary quality improvement project
Anwar Khedr1, Bijoy M Mathew2, Hisham Mushtaq1
1Research Trainee in Critical Care, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA.
Abstract:
Pseudomonas aeruginosa infection causes high morbidity and mortality, especially in immunocompromised patients. Pseudomonas can develop multidrug resistance. As a result, it can cause serious outbreaks in hospital and intensive care unit (ICU) settings, increasing both length of stay and costs. In the second quarter of 2020, in a community hospital's 15-bed ICU, the P. aeruginosa-positive sputum culture rate was unacceptably high, with a trend of increasing prevalence over the previous 3 quarters. We performed a multidisciplinary quality improvement (QI) initiative to decrease the P. aeruginosa-positive rate in our ICU. We used the Define, Measure, Analyze, Improve, and Control model of Lean Six Sigma for our QI initiative to decrease the P. aeruginosa-positive sputum culture rate by 50% over the following year without affecting the baseline environmental services cleaning time. A Plan-Do-Study-Act approach was used for key interventions, which included use of sterile water for nasogastric and orogastric tubes, adherence to procedure for inline tubing and canister exchanges, replacement of faucet aerators, addition of hopper covers, and periodic water testing. We analyzed and compared positive sputum culture rates quarterly from pre-intervention to post-intervention. The initial P. aeruginosa-positive culture rate of 10.98 infections per 1,000 patient-days in a baseline sample of 820 patients decreased to 3.44 and 2.72 per 1,000 patient-days in the following 2 post-intervention measurements. Environmental services cleaning time remained stable at 34 minutes. Multiple steps involving all stakeholders were implemented to maintain this progress. A combination of multidisciplinary efforts and QI methods was able to prevent a possible ICU P. aeruginosa outbreak.
Insights
A quality improvement initiative successfully reduced Pseudomonas aeruginosa infections in an ICU by implementing sterile water protocols and improving equipment maintenance. This multidisciplinary effort decreased infection rates by over 50% without increasing cleaning times.
Area of Science:
- Infectious Disease
- Quality Improvement
- Healthcare Management
Background:
- Pseudomonas aeruginosa infections pose significant risks, particularly in intensive care units (ICUs), leading to high morbidity, mortality, and multidrug resistance.
- An increasing trend of P. aeruginosa-positive sputum cultures in a community hospital ICU necessitated urgent intervention.
- Hospital-acquired infections, like those caused by P. aeruginosa, contribute to extended patient stays and increased healthcare costs.
Purpose of the Study:
- To implement a multidisciplinary quality improvement (QI) initiative to significantly decrease the rate of P. aeruginosa-positive sputum cultures in an ICU.
- To achieve a 50% reduction in P. aeruginosa-positive culture rates within one year using Lean Six Sigma methodologies.
- To evaluate the effectiveness of specific interventions on reducing P. aeruginosa transmission without impacting environmental services cleaning time.
Main Methods:
- A Lean Six Sigma Define, Measure, Analyze, Improve, and Control (DMAIC) model guided the QI initiative.
- Key interventions included using sterile water for nasogastric/orogastric tubes, strict adherence to tubing/canister exchange protocols, faucet aerator replacement, and periodic water testing.
- A Plan-Do-Study-Act (PDSA) approach was employed for implementing and refining interventions, with quarterly analysis of positive sputum culture rates.
Main Results:
- The P. aeruginosa-positive sputum culture rate decreased from a baseline of 10.98 infections per 1,000 patient-days to 3.44 and 2.72 per 1,000 patient-days in the two post-intervention periods.
- The initiative successfully reduced the infection rate by over 68% within the study period.
- Environmental services cleaning time remained constant at 34 minutes, indicating no adverse impact on operational efficiency.
Conclusions:
- A multidisciplinary approach combined with systematic QI methods effectively reduced P. aeruginosa-positive culture rates in the ICU.
- The implemented interventions, focusing on water safety and equipment maintenance, were crucial in preventing a potential P. aeruginosa outbreak.
- Sustained vigilance and stakeholder collaboration are essential for maintaining reduced infection rates and improving patient safety in ICUs.
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