Reducing Hospital Acquired Infections in a Major Academic Facility Using a Novel Auditing Tool

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      Hospital acquired infections (HAIs) are a major source of morbidity, mortality, and cost for healthcare facilities. Challenges to sustain best practices to prevent HAIs at our facility, leads to the creation of a Novel standard audit tool “Kamishibai cards (K-cards)”. The tool's purpose is to increase and assess staff knowledge, and to ensure compliance of best practices to prevent HAIs.


      A pre-and-post quality improvement project was conducted over 32 months, between January 2017 and August 2019, at a 953- bed, level one trauma teaching hospital.
      Starting April 2018, the K-cards were used once a week by infection preventionists (IPs) for inpatients with central lines or indwelling urinary catheters. The tool was composed of three parts: Part one, “Show me at bedside” ensured best practices were used with device insertion and maintenance to prevent infection. Part two, “Show me on the computer” ensured device indication was assessed and documented, adherence to insertion protocol was maintained, device site selection was appropriate, patient/family education, patient hygiene, and dressing change documentation were present in the patient's medical record. Part three, “Ask” verbally assessed the nurses’ knowledge regarding device maintenance and assessment of insertion site for infection.


      A 50% reduction in Central Line Associated Blood Stream Infections (CLABSIs) and Catheter Associated Urinary Tract Infections (CAUTIs) was observed. Numbers of CLABSIs were decreased from 85 to 45 and CAUTIs were reduced from 130 to 68 infections. CLABSI rate was decreased from 2.2 to 1.1 and CAUTI rate was reduced from 2.2 to 1.3. All rates per 1000 device days.


      A novel, standard audit tool that encompasses the causes of infection by involving front-line staff, is effective in reducing HAI rates, improves the rational use of devices, increases hand hygiene compliance, and potentially reduces mortality among hospitalized patients.
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