The Challenge

A health policy report in New England Journal of Medicine indicated that 5 to 10 percent of inpatients annually develop infections resulting in 90,000 deaths nationally. Compounding this, these infections generate an estimated $4.5 to $5.7 billion per year in national expense (Burke, J. P.). Significant public interest has taken root regarding the public reporting of hospital-associated infections (HAI). A growing number of states are requiring the public reporting of HAI. Patients that develop HAIs tend to be at higher risk of mortality and require significantly more and higher-cost resources.

The Response

Building on the enormous success that Michigan hospitals have achieved through the MHA Keystone: ICU project, the MHA Keystone Center for Patient Safety & Quality has launched a new collaborative available to all hospitals — Keystone: Hospital-Associated Infection, (sometimes also referred to as hospital-acquired infection). One hundred eight hospitals have committed to work together in this collaborative to eliminate patients' risk of infection.

The project goal of Keystone: HAI will be to eliminate hospital-associated infections in the hospital setting, starting with a strategic and manageable list of targeted infections. Only interventions that are consistent with evidence for scientific merit and are feasible at the bedside will be used for this initiative.

Guidance for this collaborative comes from an advisory committee that draws upon expertise from the Michigan Society of Infection Control Professionals (MSIC) and the Society of Healthcare Epidemiology of America (SHEA) along with representatives from Blue Cross Blue Shield of Michigan (BCBSM), from hospitals and others as appropriate, including the Michigan Department of Community Health and MPRO (an organization focused on health care quality improvement and patient safety initiatives).

In most participating hospitals the implementation team includes a senior executive (vice president or above), a nursing leader, physician leader and an infection control professional. Each team commits to collecting required data, attending two meetings annually, and participating in conference calls. Each team also agrees to implement the interventions as presented and to share what they learn with other teams. During the first two years of Keystone: HAI the interventions include appropriate hand hygiene, bloodstream infections, reduction of indwelling catheter use to prevent UTI, and the science of safety.