Overcoming the Status Quo with Teamwork
Faisal Masud, MD, FCCP
Methodist DeBakey Heart and Vascular Center
At the 40-bed cardiothoracic ICU at Methodist DeBakey Heart and Vascular Center in Houston, Texas, infection prevention is “a team sport.” Through a comprehensive infection prevention campaign, a cross-disciplinary team led by Faisal Masud, MD, FCCP, has produced extraordinary results in a unit where “central lines predominate and ventilator utilization is as high as it can get due to the nature of our patients.”
From January 2003 to December 2008, the unit reduced its rate of central line-associated bloodstream infections (CLABSI) from 3.6 cases per 1,000 central line days to 0.7 – including a 14-month period without any incidence of CLABSI. A total of 170 central line infections were prevented. Given a CLABSI mortality rate of 12 percent to 25 percent, an estimated 34 lives were saved. This effort also saved approximately $7.65 million.
The team also cut its incidence of ventilator-associated pneumonia (VAP) from 48 cases per year in 2003-2004 to 11 in 2004-2005. Baseline figures indicate that 120 cases of VAP were prevented. With an average cost of $40,000 each and a mortality rate of 26 percent, it is estimated that more than 30 lives and approximately $4.8 million were saved.
“Infection prevention became my passion after watching its impact on my patients, first-hand, in the ICU. Their pain, suffering and death became a constant reminder that the status quo is not good enough,” said Dr. Masud, unit medical director. “Everyone in patient care has a role, and it is everyone’s responsibility.”
He gathered a team of physicians, infection preventionists, physician assistants, respiratory therapists and administrators to perform a GAP analysis, and review and implement evidence-based best practices.
The process began with education, and implementation of a mandatory infection prevention course for residents prior to their work in the ICU. Other steps included glucose control protocol, daily assessment of central lines, ventilator fast track extubation protocol, and use of a ventilation bundle. The team also used Chlorhexidine prep, antiseptic/antimicrobial catheters, maximal sterile barrier kits, a central line cart, humidified ventilator circuits, and in-line suctioning. The team conducted dressing change audits, and encouraged more frequent tooth brushing and use of mouthwash among patients.
“We constantly brought back all the results to the team of stakeholders. We learned from our mistakes and kept changing everything, using the latest technology,” he said. “I look at anything I can do to reduce infection. I would like to keep it at zero. You have to have patience, and the willingness to persevere.”