Division of Infectious Diseases

In endeavoring to give you a real flavor of how important patient safety is to all of us, we have more comments today from our team. Patient safety is important to all of us and we wish we could highlight the all of important work everyone in our Division is doing to provide the best possible care while still preventing harm.

Adrienne Sy, RN, BSN; Quality Lead for CLABSI & CAUTI reduction starts us off today:

Patient safety means protecting someone’s loved one from harm.  My grandmother passed away after a fall two weeks before I took the NCLEX, and my mother-in-law passed away after a bloodstream infection three months after I got to marry her eldest son.

Two things that I am very excited to help run/coordinate are the CAUTI and CLABSI Roundups.  It gives me a chance to work with the nursing units, and I believe that these have been very helpful in identifying what is done well and what our areas of opportunity are.

Michelle Schwedhelm, RN adds a great global view of safety at Nebraska Medicine/UNMC:

Patient Safety is creating a safe zone and processes for patients seeking care at Nebraska Medicine. 

One project is doing Fire and Severe Weather Drills with our staff to assure they know how to evacuate and how to mitigate danger for our patients.  Another is our new Daily Shout Out meeting where we identify safety issues for patients and staff and encourage prompt resolution.  Visibility is at the highest levels of the organization.

Dr. Kelly Cawcutt on preventing harm in the ICU:

Dr. Kelly Cawcutt, Associate Director of Infection Control and Epidemiology

Patient safety is about always providing the best patient-centered care while preventing harm, for all patients. I work in the ICU also, and there we are providing care to the sickest patients in the hospital and often have to use invasive procedures and devices for life support measures. Providing excellent clinical care is one component of patient safety, but through working in Infection Control, I can also focus on preventing harm are a larger scale from how we prevent the spread of infections in the hospital to which types of devices we use in the ICU. 

Some examples of projects I have worked on are developing a vascular access algorithm to ensure we use the right device at the right time for our patients – whether that is a peripheral IV, midline, central venous catheter or another type of device. I also am working on how to address and prevent ventilator-associated events, including pneumonia, for our patients who require mechanical ventilation in the ICU. These projects reduce harm, prevent adverse events and in the end, I believe this work helps save lives. 

To me, patient safety is about imagining yourself as each patient or family member being cared for in the hospital, and asking “is the care I’m delivering what I would want for myself or my family?”, and if the answer to that is “no”, personally seeking ways to improve that care for our patients. 

Dr. Jasmine Riviere Marcelin is the Associate Medical Director, Nebraska Medicine Antimicrobial Stewardship Program

Much of my work in Antimicrobial Stewardship is focused on reduction of antibiotic use, primarily with a patient safety mission. Antibiotics are the only drugs where an individual prescriber’s use can affect patients s/he never even cared for. For example, when patients are prescribed antibiotics for viral illnesses which do not require them, this may lead to development of bacteria resistant to antibiotics. When a patient in that community then develops a serious bacterial infection with this resistant organism, they may face grave complications from the actual bacteria or from use of alternative antibiotics with serious adverse effects or toxicities. Collaborating with the Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) and Nebraska Health Network (NHN), I created several educational materials for outpatient prescribers on appropriate use of antibiotics in upper respiratory illnesses.

Additionally, skin/soft tissue infections are another area where antibiotics are overused, and I personally have seen patients develop kidney failure from combination treatment with vancomycin and piperacillin-tazobactam for cellulitis when only cefazolin was indicated. I am currently working on updating our institutional skin/soft tissue infection guidance document which will help antibiotic prescribers make the right treatment choices for specific skin/soft tissue infections. These are just two of the many projects our Antimicrobial Stewardship Team are working on to decrease antibiotic overuse and misuse, keeping patients safe by reducing adverse effects, drug toxicities and antibiotic resistance. 

As mentioned on Monday, patient safety is a primary focus of our work, particularly in Infection Control and Epidemiology. To really highlight the commitment to this initiative, we wanted to share a series on what patient safety means to us and a few examples of how we have implemented that into our work.

Per Dr. Mark Rupp,  Division Chief and Medical Director of Infection Control & Epidemiology:

Patient safety, is the very reasonable expectation from our patients, that although in healthcare we do things that are inherently dangerous, we minimize the risk of harm as much as is possible.  Quite simply, we eliminate preventable harm.

In the Infection Control and Epidemiology Department our whole effort is dedicated toward minimizing the occurrence of healthcare associated infections (HAIs). 

In recent years at Nebraska Medicine we have taken aggressive measures to decrease central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).  We emphasize horizontal interventions which are measures that impact all patients or broad groups of patients – examples of horizontal interventions are hand hygiene, chlorhexidine bathing, and environmental cleaning and disinfection.  At the present time we are in the middle of a campaign to decrease infection due to Clostridium difficile and launching programs to further limit infections following surgery (surgical site infections).  Much of the work we do is behind the scenes and includes making sure the air is safe, the water is free of pathogens, and systems to provide clean and sterilized instruments and devices are working properly.” 

Dr. Angela Hewlett, Medical Director of Clinical Operations for the Biocontainment Unit,  Associate Medical Director of Infection Control & Epidemiology and Director of Infectious Diseases Outpatient Clinic said:

To me, ‘patient safety’ is the practice of doing everything we can to prevent harm from coming to our patients.  Patient safety protocols should be based on the best available scientific evidence and always be accompanied by education (for healthcare workers as well as patients).

 Examples:

1. After it was noted that patients with fractures were placed on a variety of antibiotic regimens in an effort to prevent infections, I worked on a collaborative project with the Department of Orthopaedic Surgery to standardize antibiotic recommendations for patients with fractures.  We created an Epic order set, and conducted educational sessions with multiple physician groups, including the Emergency Department, Trauma Surgery and Orthopedics.  This evidence-based protocol will help with patient safety by ensuring that patients are receiving appropriate antibiotics and dosing for an appropriate amount of time. 
2.  Chlorhexidine (CHG) bathing is a modality that has been shown to decrease healthcare-associated infections, and is a standard practice for all inpatients at UNMC.  Dr. Andrea Green and I created a survey of nursing staff to determine what barriers exist in regards to CHG bathing of patients.   We used the information generated from the survey to create education on the benefits of CHG bathing in an effort to increase compliance with this practice. 

Kim Hayes, RN and Infection Preventionist added her perspective with:

What does patient safety mean to me?  First and foremost, we must not harm our patients during the course of their treatment, either in our cares or with our devices.  We must be mindful that our patients were not always as we see them and their families have the expectation that we will keep them safe and not let harm come to them while they stay with us.

Two projects that I have been involved with were the CAUTI reduction team during which every nurse/tech in the facility was instructed in catheter insertion and appropriate catheter cares, supply lines were standardized and we updated our devices(sterile piston irrigation set).  The second was moving from the outdated split septum IV infusion sets and connectors to meet the industry standard with the needleless sets and connectors.  This was an enterprise wide change that touched every department and made IV treatment safer.  Alligator clips no longer popped off and infused medications into the bed linens, needles were no longer used in the system, so nurses are safer today as a result.  

Learn more about ID and Infection Control at UNMC.