ISR 59 - Collaboration, Consistency, and Communication- oh My! Decreasing Hospital-acquired Infections in a Tertiary Hospital’s Medical Surgical Intensive Care Unit

Background: The Medical Surgical Intensive Care Unit’s (MSICU) patient acuity, complexity, and propensity to deterioration was catalyzed by early 2020 COVID-19 patient admissions. This led to a significant increase in reportable Central Line Associated Bloodstream Infections (CLABSI) and Catheter Associated Urinary Tract Infections (CAUTI). Despite COVID-19 numbers subsiding in Summer 2020, patient population remained highly complex and Hospital-Acquired Infections (HAI) did not decrease. Leadership, unit-based committees, and multidisciplinary colleagues were aware that the established evidence-based strategies for HAI reduction and prevention would be insufficient to prevent harm.

Methods: In tandem with reeducation surrounding CAUTI and CLABSI prevention, strategies of collaboration, consistency, and communication were used routinely starting December 2020. Collaboration between Infection Prevention (IP) and MSICU Nursing created mutual learning opportunities, care-conferences for high-risk patients, and shared unit-based data, including Standard Infection Ratios (SIR). Consistency was a key factor in reviewing HAIs through Apparent Cause Analysis’ (ACA) between the collaborative team. Summaries following ACAs were highlighted and disseminated in daily huddles, an anonymous web-based survey platform, meetings, and more to reinforce effective communication with feedback and engagement.

Results: MSICU had a consistent reduction in both CLABSI and CAUTI events from 2020 to December 2022 – from a CLABSI SIR of 2.3 in 2020 to a CLABSI SIR of 0.327 in 2022 and a CAUTI SIR of 1.299 in 2020 to a CAUTI SIR of 0.863 in 2022. Collaboration, consistency, and communication lead to the unit achieving an 87.5% reduction in CLABSIs and a 50% reduction in CAUTIs over two years.

Conclusions: Breaking barriers to communication and working as a multi-disciplinary team to strategize methods of prevention is integral to the success of HAI reduction efforts. Additionally, utilizing already existing communication platforms, such as web-based platforms, can bolster a culture of harm-prevention and holistic, proactive care to a high-risk population.