Advocate Condell Hospital: Improving Process to Improve Infection Prevention and Control

In hospitals and health systems across the country, the fight against Clostridioides difficile infections (CDI), catheter-associated urinary tract infections (CAUTI) and other infections is a priority for improving patient safety. To reduce infection rates more effectively, hospitals and health systems are focusing on the fundamentals. For Advocate Condell Hospital, the focus is on process improvements.

The concept is simple: Eliminate unnecessary variation in patient care by streamlining clinical workflows and ensure the use of evidence-based best practices. When successfully implemented, this strategy addresses the challenges of conditions like CAUTI and CDI, reducing patient infection rates and the negative impacts they inflict.

Improving processes at Advocate Condell Hospital looks like this:

• The hospital formed a multidisciplinary team, including infection prevention, quality, nursing and leadership. This multidisciplinary approach drives critical knowledge sharing so that everyone on the team has the information needed to be successful in their role; it also ensures knowledge is consistent throughout the organization. Key roles:
  • Charge nurses served as nurse champions early in the project; multiple and flexible education was targeted at them and rolled out to busy, bedside nurses.
  • Physician champions increased collaboration and trust between nurses and physicians. An approachable physician advisor served as an intermediary between nurses and physicians, and guided peer physicians on culturing stewardship. An infection prevention chair physician further served as a content expert and weighed in on decision making around ordering urine cultures.
• High risk huddles were conducted to help minimize risk and enhance opportunities in real time making it easy for nurses to initiate support, meet compliance standards and communicate with transparency.
• An escalation process was created when obtaining blood cultures from patients with central lines.
• Because device utilization correlates with device-associated complications and rates of infection, the hospital implemented daily device huddles with all inpatient unit managers. They report out patients with indwelling urinary catheters and/or central lines, as well as any cultures that were sent. The daily device huddles allow teams to evaluate the impact of the devices and rates of infection.
• A drilldown process after all CLABSI and CAUTI events was implemented to uncover and share improvement opportunities across units.
• Their health outcomes meetings now include a representative from their shared governance committee to provide the voice of bedside nurses. Bedside nurses have regular access to nurse leaders and physicians to implement best practices in a way that feels more like a partnership rather than a hierarchy. This approach helps build trust and credibility.

With these interventions, the team successfully reduced CLABSI (11 in 2021, 4 in 2022) and CAUTI (7 in 2021, 2 in 2022).

The COVID-19 pandemic and recent surges in respiratory illness did not impact the hospital’s interventions. If anything, clinical teams became more hyperaware of the interventions set forth and vigilant about structure, process and outcomes. Of course, there were obstacles along the way that would cause care teams to adjust processes, but the strategy remains on consistently deploying interventions that they know are working.

According to the hospital, one of the key takeaways from this renewed focus on process is that when you stick to tried and true practices, you yield positive results.