May 9, 2008

Deaths from infection fall at area hospitals

Bay collaborative claims better training led to drop in fatalities

By Suzanne Bohan / Bay Area News Group

Nurses at Kaiser Permanente's South San Francisco medical center took a cue from the construction industry when they started wearing bright yellow vests last year while administering drugs to patients.

Their message? Stay clear and don't interrupt me - this is a risky job.

"People recognized that the primary problem with medicine delivery is that nurses kept getting interrupted and distracted during the process," said Barbara DeBaun, R.N., an improvement adviser for the Beacon Collaborative, a Walnut Creek-based nonprofit that spearheads accelerated adoption of safety practices at 39 Bay Area hospitals.

Last month, the collaborative also announced that it estimates that 194 lives were spared inside Bay Area medical centers during a 21-month period in 2006 and 2007 by training staff to prevent two types of common, but often fatal infections, by following a set of established guidelines.

"I think this is the tip of the iceberg," DeBaun said, referring to the number of lives saved among the 450,000 annual hospital admissions in the Bay Area.

In describing the drive behind the adoption of yellow vests for nurses, DeBaun referenced the prevalence of sometimes fatal medication errors that were identified as a leading cause of preventable deaths in the nation's hospitals in a 1999 Institute of Medicine report.

Up to 98,000 deaths a year are caused by preventable medical errors in U.S. hospitals, the report noted, costing $17 billion to $29 billion per year in medical costs, as well as lost productivity and disability. That report serves as an impetus for initiatives like those run by the Beacon Collaborative.

"When they wear a yellow safety vest, it means no one is allowed to talk with them, it means no one is allowed to distract them," DeBaun said. "It's in recognition that when nurses are giving medication, they need to be focused on that, and only that."

The yellow vests worn by a growing number of nurses in Bay Area hospitals give testament to scores of new initiatives started by the collaborative.

In the local facilities, there was a dramatic 60 percent decline in ventilator-associated pneumonia by training staff to follow a set of patient-care protocols. Those steps include keeping the patients reclined at a certain angle and allowing them to periodically go off sedation.

Nationwide, ventilator-associated pneumonia accounts for some 35,000 deaths annually, and at a cost of nearly $10,000 per infection, the collaborative noted, citing federal statistics.

The Beacon Collaborative, formerly called The Bay Area Patient Safety Collaborative, also reported a 66 percent decline in bloodstream infection caused by intravenous lines that lead to deep veins. These "central line-associated infections" cause as many as 21,000 deaths in the U.S. each year at a cost of $36,000 per infection, according to statistics cited by the collaborative.

The IV lines, which create an open gap in the skin, are easy paths of entry for bacteria and a common cause of life-threatening blood infections - called sepsis - for hospitalized patients. Most patients in intensive care units have central venous catheters, which DeBaun called "very, very risky."

The decline in infections from these IV lines was credited to training health care workers to adhere to a set of simple procedures like adequate hand washing, as well as better monitoring for infections and optimal placement of the line. These sets of procedures are called "bundles," and it's critical that no step is missed to ensure the best outcome, DeBaun said.

"It's like making a cake," she explained. "You've got to have all the right ingredients, or it's not going to come out right."

The collaborative, funded by the Gordon and Betty Moore Foundation in San Francisco, is a voluntary affiliation of 39 hospitals in Alameda, Marin, San Francisco, San Mateo and Santa Clara counties. Members include most of the hospitals in these counties, including Kaiser Permanente medical centers; Alta Bates Summit Medical Center in Berkeley; and Oakland, San Mateo Medical Center and the Santa Clara Valley Medical Center.

The collaborative focuses adoption of evidence-backed medical practices for achieving the best results of medical procedures, through seminars, webcasts and conference calls, among other avenues. Notable in the collaboration is the free sharing of practices among hospitals that are also competitors.

"The important message is competitors are sharing," DeBaun said. "It's a whole new frontier."

Madge Kaplan, director of communication for the Institute for Healthcare Improvement, a Massachusetts organization directing the "5 Million Lives" campaign, said these initiatives are starting to turn the tide.

"Slowly but surely, hospitals have been getting their acts together," Kaplan said. "There is something changing, and the improvements that are going on out there are an untold story."

And the work of the Beacon Collaborative is providing a national example, added Joe McCannon, vice president of the Institute for Healthcare Improvement.

"Through their outstanding work, they're setting an example," he said. "They're leading us in some ways."