President's Perspective

Getting Results in our Fight Against Infections

Thomas M. Priselac, President and CEO

One of the most visible signs of Cedars-Sinai's commitment to patient safety is our hospital-wide hand hygiene campaign. The message that "clean hands save lives" is hard to miss, with reminders posted on elevator doors and in many other locations around the hospital and hand sanitizer dispensers in every patient room and waiting area.

Hand hygiene is just one part of a much more extensive effort throughout Cedars-Sinai to eliminate hospital-acquired infections. This is a nationwide concern; each year, nearly two million patients in the United States acquire an infection while in the hospital. The comprehensive infection-control campaign we launched in 2007 is one of the most aggressive in the nation.

The complexity and diversity of hospital-acquired infections requires that the search for solutions involve a wide variety of departments and individuals. As a result, the Hospital-Acquired Infections Task Force - the group leading our efforts to eliminate these infections - includes representatives from our Medical Staff, Nursing, Facilities, Epidemiology, Microbiology, Performance Improvement, Communications and many other departments. Their assignment: look for every possible way to eliminate all germs that pose a threat to our patients. This requires not only teamwork, diligence and research, but a willingness to think creatively about innovative tests-of-change we can pilot.

When our Quality Council initiated this process, Cedars-Sinai already had a low infection rate by national standards, but we set out to do even better - to pursue the ambitious goal of zero infections.

Our task force members have recommended a number of changes that have been successfully implemented, and they continue to explore innovative measures in five key areas: hand hygiene, decontamination of equipment and the environment, surveillance, contact precautions, and the management of central lines to reduce bloodstream infections.

We're starting to see results in all of these areas. We recently celebrated "Zero Day" to acknowledge some of these achievements, and to encourage everyone at Cedars-Sinai to continue to work on our collective efforts to get to zero. For example, we recognized the work of our Environmental Services team, which has been instrumental in eliminating multi-drug resistant organisms (MDROs) from patient privacy curtains. We've found zero MDROs on patient curtains since we first hit this target last August. This is due in large part to a successful test-of-change we tried last year with a new type of curtain, as well as the diligence of our EVS staff.

We also achieved a zero rate of central line-associated bloodstream infections hospital-wide in several recent months after we implemented a number of recommendations from our task force, including a new policy to ensure that central lines are replaced more frequently to prevent infection, as well as new cleaning procedures to help eliminate bacteria more effectively. This zero rate also reflects the high level of dedication to patient safety that is demonstrated by our excellent nursing staff in countless ways every day.

Successes such as these demonstrate that we're doing the right things to achieve our goal of zero infections hospital-wide. It will take a relentless effort to sustain and build on the significant progress we’ve made, but I'm confident that we’ll continue to get results because the awareness that is so important to change is becoming an intrinsic part of our organizational culture.

One of our biggest challenges is the fact that the fight against hospital-acquired infections can never end. No matter how successful we are, it will take constant vigilance to protect our patients. This is particularly true when it comes to hand hygiene. Although we are seeing improvements in hand-hygiene compliance, we need to do even better. As an institution, we should accept no less than 100 percent compliance in hand hygiene. And even then, we will have to guard against the tendency to become complacent. Maintaining the highest level of compliance will require a conscious effort by all of us to follow hand hygiene procedures at all times - without fail.

As we continue to put the best possible infection-control procedures in place, we welcome your suggestions. Thank you for your commitment to quality and safety. The strength of this commitment, and the way it is demonstrated every day throughout the Medical Center, is what makes Cedars-Sinai a model for so many other hospitals across the nation.