Sanjay Saint, MD, MPH; Jennifer Meddings, MD, MSc; Karen E. Fowler, MPH; Valerie M. Vaughn, MD, MSc; Jessica M. Ameling, MPH; Jeffrey M. Rohde, MD; Kyle J. Popovich, MD, MS; David P. Calfee, MD, MS; Sarah L. Krein, PhD, RN; Vineet Chopra, MD, MSc
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Centers for Disease Control and Prevention, the American Hospital Association, or the Department of Veterans Affairs.
Acknowledgment: The authors thank the Health Research & Educational Trust Health Care-Associated Infection team, as well as the National Program Team and all members of the Centers for Disease Control and Prevention STRIVE collaborative.
Financial Support: Additional support was received from the Agency for Healthcare Research and Quality (K08 HS19767) and the Department of Veterans Affairs (Health Services Research & Development Service RCS 11-222, and National Center for Patient Safety Ann Arbor Patient Safety Center of Inquiry).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3443.
Corresponding Author: Sanjay Saint, MD, MPH, George Dock Professor of Internal Medicine, University of Michigan Department of Internal Medicine, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Saint and Meddings: University of Michigan Department of Internal Medicine, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800.
Ms. Fowler and Dr. Krein: Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170.
Dr. Vaughn: University of Michigan Department of Internal Medicine, 2800 Plymouth Road, Building 16, Room 472C, Ann Arbor, MI 48109.
Ms. Ameling: University of Michigan Department of Internal Medicine, 2800 Plymouth Road, Building 16, 4th Floor, Ann Arbor, MI 48109-2800.
Dr. Rohde: University of Michigan Department of Internal Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109.
Dr. Popovich: Rush University, 600 South Paulina, Suite 143, Chicago, IL 60612.
Dr. Calfee: Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065.
Dr. Chopra: University of Michigan Department of Internal Medicine, 2800 Plymouth Road, Building 16, Room 432W, Ann Arbor, MI 48109-2800.
Author Contributions: Conception and design: S. Saint, J. Meddings, K.E. Fowler, V.M. Vaughn, J.M. Ameling, J.M. Rohde, D.P. Calfee, S.L. Krein, V. Chopra.
Analysis and interpretation of the data: S. Saint.
Drafting of the article: S. Saint, K.E. Fowler, V. Chopra.
Critical revision of the article for important intellectual content: S. Saint, J. Meddings, K.E. Fowler, V.M. Vaughn, J.M. Ameling, J.M. Rohde, K.J. Popovich, D.P. Calfee, S.L. Krein, V. Chopra.
Final approval of the article: S. Saint, J. Meddings, K.E. Fowler, V.M. Vaughn, J.M. Ameling, J.M. Rohde, K.J. Popovich, D.P. Calfee, S.L. Krein, V. Chopra.
Obtaining of funding: S. Saint, V. Chopra.
Administrative, technical, or logistic support: K.E. Fowler, J.M. Ameling.
Overview of development of infection-specific GPSs.
CAUTI = catheter-associated urinary tract infection; CDI = Clostridioides difficile infection; CLABSI = central line–associated bloodstream infection; GPS = guide to patient safety; MRSA = methicillin-resistant Staphylococcus aureus.
* Available at www.catheterout.org/cauti-gps.html.
† Available at http://psep.med.umich.edu/gpscdi.html.
‡ Available at www.improvepicc.com/gpsclabsi.html.
§ Available at http://psep.med.umich.edu/gpsmrsa.html.
Instructions for the CDI GPS.
CDI = Clostridioides difficile infection; GPS = guide to patient safety.
You indicated that either you do not have a team leader or that the one you have does not have appropriate time for CLABSI prevention. The team leader is responsible for coordinating the CLABSI prevention efforts—collecting data, organizing reports, presenting outcomes and tracking progress. It is their responsibility to keep the improvement moving forward and coordinate all the moving pieces between stakeholders. It is unlikely that the CLABSI prevention initiative is the only responsibility of the team leader, and because of this, there may not be enough time devoted to the prevention efforts. Creating that dedicated time is imperative to a successful initiative.
You indicated that your hospital does not have a system in place, or the existing system does not function well, for communicating confirmed cases of MRSA to frontline care staff. An important component of preventing MRSA is early identification of patients with MRSA and notification of those involved in the care of that patient. Early identification and notification allows for the placement of these patients into Contact Precautions and modifications to daily patient care activities. Thus, it is imperative that frontline staff are aware of a patient's MRSA status. Nursing champions can play a pivotal role in helping ensure a communication system is in place and properly followed.
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Saint S, Meddings J, Fowler KE, et al. The Guide to Patient Safety for Health Care–Associated Infections. Ann Intern Med. 2019;171:S7–S9. doi: https://doi.org/10.7326/M18-3443
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Published: Ann Intern Med. 2019;171(7_Supplement):S7-S9.
Hospital Medicine, Hospital-Acquired Infections, Infectious Disease, MRSA, Nephrology.
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