NUMC receives award for improving care

Bloodstream infections caused by catheters inserted in large veins — known in the medical field as central lines — are one of the most serious hospital-acquired infections, according to the Centers for Disease Control and Prevention, but also the simplest to prevent. In an effort to reduce these avoidable dangers, the Nassau University Medical Center increased staff education to focus on sterilization and improved insertion of catheters. These efforts, and others, have led to a reduction in infection rates of 74 percent, which earned the facility national recognition.

A central venous catheter is a tiny, sterile tube that is inserted in a vein and carries medication or nutrients into the body, Dr. Steven Walerstein, chief medical officer at NUMC, explained. However, this external line can also carry harmful bacteria into the blood. Recognizing this problem, NUMC adopted an initiative to address it.

The hospital’s president, Arthur Gianelli, attended the National Association of Public Hospitals and Healthy Systems conference on June 21 in San Francisco, and, on behalf of the staff, accepted the 2012 Gage Safety Net Award for Improving Quality and Patient Safety. NUMC was chosen from among 36 submissions for the award.

A leadership team of doctors, nurses and quality management specialists “aggressively educated staff” on ways to reduce central line infections through email blasts, auditorium lectures and presentations, Walerstein said. He added that treating the insertion of a catheter like a surgical procedure is one way to prevent infection. Staff members were reminded to always wear gowns and gloves, and to sterilize the insertion site.

In addition to thoroughly cleansing the central line, choosing the best location for the catheter is also an important step, Walerstein explained. Previously, medical personnel often aimed for the femoral vein in the thigh, he said, but using the subclavian vein in the chest usually results in lower infection rates. With the benefit of this updated information, physicians and nurses were shown the best way to insert subclavian catheters, and practiced until they felt comfortable performing the procedure.

“A central line infection should not occur,” said Walerstein, but despite best efforts, there are still reported occurrences at NUMC. However, when infections do arise, those involved take part in an “aggressive drilldown” in which they try to determine why the infection emerged and discuss ways to prevent it in the future.

In addition to improving patient safety, decreasing central line infections will also increase hospital funding. The Department of Health and Human Services launched an initiative last year that rewards hospitals based on the quality of care they provide Medicare patients.

“Authorized by the Affordable Care Act, the Hospital Value-Based Purchasing program marks the beginning of an historic change in how Medicare pays health care providers and facilities,” the HHS said in a statement. “For the first time, 3,500 hospitals across the country will be paid for inpatient acute care services based on the care quality, not just the quantity of the service they provide.”

NUMC instituted steps over the past year to engage patients and families in central line care and produced measurable results, said Carl Graziano, a spokesman for the National Association of Public Hospitals and Healthy Systems. “It’s clear that their work contributed greatly to care quality and patient safety.”

Gianelli congratulated the NUMC clinical team for “diligently” and “dramatically improving” patient care. “NUMC is a special hospital,” he added, “one where, with each passing month, our quality data matches or exceeds some of the best hospitals around, a credit to our staff.”

According to data from 2010, the most recent information provided by the New York State Department of Health, hospitals began reporting hospital-acquired infections to the state in 2007. Since then, facilities have been monitored continuously, and are given feedback on ways to reduce infections.