at St. Luke's Magic Valley
St. Luke’s Magic Valley is committed to the prevention of hospital-acquired infections—infections that patients acquire after being in a health care environment. Also called health care-associated infections or HAIs, they are typically caused by bacteria and other microorganisms that naturally live on the skin but find their way into a surgical incision.
HAIs increase patient stays, hamper their recovery, increase their medical expenses, and can lead to disabling conditions or even death.
“We don’t have a high infection rate at Magic Valley,’ says Infection Prevention nurse Trish Heath, “but even one infection is too many.”
That’s why St. Luke’s constantly works to implement protocols to prevent HAI and to educate patients and caregivers. St. Luke’s participates in national initiatives to reduce HAI and uses proven prevention measures in innovative ways.
Qualis Health Award of Excellence in Healthcare Quality
One of those innovations brought recognition to St. Luke’s Magic Valley in 2009 with a Qualis Health Award of Excellence in Healthcare Quality for “Pre-Op Shower Kits: Reducing the risk for surgical site infections.”
The Pre-Op shower kits were a cooperative effort among the Infection Prevention, Peri-Anesthesia, Pre-Admissions, and Surgery departments at St. Luke’s, and orthopedic spine surgeon Dr. David Christensen and his staff. The kits were designed to decrease the chance of patients acquiring an infection following surgery, leading to shorter hospital stays and faster recovery time.
The project began in May 2008. Shower kits were given to patients undergoing spine procedures and total knee and total hip replacements. These procedures were chosen because they are considered high risk for severe side effects if a surgical site infection (SSI) should occur. Patients who acquire an infection after one of these procedures can easily end up back in the hospital.
The shower kits contain a netting body scrubber; a 4-ounce bottle of an antiseptic, antimicrobial skin cleanser containing chlorhexidine gluconate; a 0.5-ounce bottle of Purell hand sanitizer; a thermometer; showering instructions; and information on the things patients can do before and after surgery to reduce their chance of an SSI.
Since the shower kit project began, the occurrence of SSIs dropped 66 percent, and St. Luke’s plans to branch out and use the shower kits in additional orthopedic practices.
Infection Prevention Initiatives
In 2007, St. Luke's Magic Valley received the VHA Award for Excellence in Critical Care for our TICU (Transformation of the ICU) program. TICU is a national clinical effort to support evidence-based practice initiatives that improve outcomes and safety for patients in critical care units. The award honors organizations that have distinguished themselves by achieving national performance standards.
In 2005, St. Luke’s Magic Valley joined the Institute of Healthcare Improvement’s (IHI) nationwide campaign to save 100,000 lives by implementing best practices to reduce unnecessary deaths, including those from ventilator-associated pneumonia (VAP).
VAP is the leading cause of death among hospital-acquired infections, and can add an estimated cost of $40,000 to a typical hospital admission. VAP prevention has always been a priority of Intensive Care and Respiratory Therapy staff members at St. Luke’s; before joining 100,000 Lives, we averaged four to five VAPs per year. Now, through even more careful attention, we have had only one instance of VAP since December 2005.
The 100,000 Lives campaign was followed by the 5 Million Lives campaign, which continued the IHI initiatives. Central to these campaigns is the “bundle” concept, a practice that is gaining wide acceptance across the country. A bundle is a collection of processes that are needed to effectively care for patients undergoing a particular treatment. The idea is to bundle together several scientifically grounded elements essential to improving clinical outcomes.
For example, the VAP prevention bundle includes keeping the patient’s head elevated at 30 degrees, providing good oral care every two hours, watching to see if the patient can come off the ventilator, keeping them ventilator-free for a trial run to see if they can sustain it, and watching for reflux and treating it with medication if necessary.
St. Luke’s also has procedures in place to prevent central line-associated bloodstream infections. These include best practices for inserting the line and keeping the site sterile, constant monitoring of the site, and removing the line as soon as possible. We have developed a kit that includes the use of maximum barriers upon insertion, such as a mask, gloves, drape, and chlorhexidine cleanser, as well as a checklist for caregivers to follow.
St. Luke’s has also developed a Foley catheter bundle kit to prevent catheter-associated urinary tract infections, and educational campaigns for caregivers and patients on the critical importance of hand hygiene. Housekeeping and engineering staff have processes in place that use best practices to keep the hospital as clean and safe from infection as possible.
Patients receive information on caring for their wounds and watching for signs of infection after they leave the hospital, such as redness, pain, or swelling at the surgical site, new drainage or change in the way the drainage looks; a rise in temperature; and a change in overall feeling, such as nausea, vomiting, fatigue, dizziness, or trouble breathing.
St. Luke’s Magic Valley has developed patient information booklets on Methicillin-Resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C.diff) infections that are now published throughout the St. Luke’s System, and a booklet on multi-drug-resistant organisms geared toward health care providers.
For more information on infection prevention efforts at St. Luke’s Magic Valley, contact Trish Health, Infection Prevention nurse, at firstname.lastname@example.org or 814-5120.