Zero infections

Piedmont Medical Center to work with other S.C. hospitals to increase patient safety

By Mary Jo Balasco - The Herald

Piedmont Medical Center has joined forces with other South Carolina hospitals in an ongoing effort to eliminate infections that patients pick up in the hospital, officials say.

"We're pushing for zero infections," chief medical officer Richard Patterson said.

The hospital is one of the state's 65 acute care hospitals that are participating in the South Carolina Healthcare Quality Trust -- a voluntary hospital and research university initiative that will address health care quality challenges.

"It's a collaboration of all the hospitals, which allows us to exchange the best practices and allows everybody to take their focus to an entirely different level," Piedmont CEO Charlie Miller said.

The trust includes Health Sciences South Carolina, the South Carolina Hospital Association and the Premier Healthcare Alliance. The three partners plan to invest more than $1.7 million over three years in the effort.

It includes the state's largest research universities through Health Sciences South Carolina -- Clemson University, the Medical University of South Carolina and the University of South Carolina -- and others through the state hospital association.

The first project will be to eliminate preventable infections caught by patients in the hospital -- the leading cause of disability and death in the U.S., Patterson said.

"We all know someone whose life has been altered, sometimes permanently, by a preventable infection," Health Sciences president and CEO Jay Moskowitz said.

Through the trust, he said, "We will be using our state's best researchers to determine the causes of specific infections. We will test solutions in our state's four largest health systems, which today treat about 30 percent of all patients. We will then share the best practices, products and services that result with all South Carolina hospitals."

Each year, the Centers for Disease Control and preventiom estimates there are 1.7 million infections and 99,000 related deaths in U.S. hospitals, which costs the nation's health care system $6.2 billion.

Eliminating these infections could save South Carolina hospitals as much as $40 million and cut hospital stays by up to 24,000 days, according to the hospital association.

Piedmont will work with other hospital via teleconferences and will share research and ideas on how to reduce infections and handle other health care concerns, Patterson said.

The Rock Hill hospital already has been working to combat hospital acquired infections, Patterson said. In 2006, it collaborated with Duke University Health System, which compared Piedmont's infection rates with those of other hospitals and offered suggestions.

Measures already taken to combat such infections include:

• Screening for MRSA, or Methicillin Resistant Staphylococcus Aureus, a bacteria resistant to the antibiotic commonly used to treat it. MRSA is a frequent culprit of hospital infections, Patterson said.

All admitted patients, except for obstetrics patients, get an MRSA test by swabbing inside their nose. Until results come back in 24 to 48 hours, anyone entering their room must wear a gown and gloves, Patterson said. If a patient tests positive, they are treated with an antibiotic nasal ointment, which kills the bacteria.

Patterson said 6 percent of all patients admitted have been carriers of MRSA. He said studies show the number of people carrying MRSA has doubled because of antibiotics, which can cause bacteria to mutate and become resistant to treatment, he said.

• Removing hair from surgical sites with clippers instead of a razor, because clippers cause less breakage of the skin, which can allow bacteria to enter the wound.

Piedmont reported four hospital-acquired surgical site infections from June 2007 to November 2008, according to the S.C. Department of Heath and Environmental Control.

• Routinely giving patients an antibiotic within one hour of surgery so that tissue antibiotic levels around the surgical site can kill or inhibit bacteria, Patterson said.

• Reducing ventilator-associated pneumonia. The ventilator tube placed down the throat displaces the vocal cords, a normal barrier to the bacteria that can cause pneumonia.

In February 2008, the hospital began a protocol that has cut in half the length of time a person would usually stay on a ventilator, reducing its ventilator associated pneumonia rate by 75 percent, Patterson said.

• Changing routine orders regarding catheters. Beginning in January, patients with bladder catheters are evaluated against a list of criteria. When the patient no longer meets criteria for needing a catheter, a nurse can automatically discontinue it.

But Patterson said the measure that makes the biggest difference in hospital-acquired infections is also the simplest: hand-washing.