Linda Becker

An effective continuous quality improvement approach to the prevention of ventilator-associated pneumonia.

In 1989, our medical center used continuous quality improvement concepts in the creation of a Nosocomial Pneumonia Prevention Team whose aim was to significantly reduce nosocomial ventilator-associated pneumonia. The team included representatives from nursing, respiratory therapy, pulmonary medicine, internal medicine, anesthesiology, education and training, and infection control. Because the majority of mechanically ventilated patients were located in the intensive care unit, this unit became the focus of the prevention efforts. Team meetings were held regularly, with all representatives brainstorming barriers, possible interventions, methods of outcome measurement, and frequency of evaluation. Policies and procedures were reviewed, surveillance was increased, handwashing practices were surveyed, periodic feedback to staff was begun, and an educational program was developed and presented. During 1990, we observed a 57% reduction in ventilator-associated pneumonia from the baseline years, 1987 and 1988. Statistical comparison of proportions by z test indicated a p value less than 0.05. Fifteen cases of nosocomial ventilator-associated pneumonia were prevented and a cost saving of

Departmental role and scope in infection conrol: Use of a template that meets joint commission requirements

105,000 was realized. Performance of traditional surveillance for outliers, coupled with literature-based thresholds, can lead to tolerance of inordinately high endemic rates. Infection control programs can significantly reduce endemic rates of nosocomial ventilator-associated pneumonia through continuous quality improvement methods and multidisciplinary interventions, with standard infection control procedures used for improvement.

Standardizing glutaraldehyde use in a regional group of ten major medical centers

Since its inception in 1990, departmental role and scope in the infection control program have developed into the five important aspects currently defined by the Joint Commission. Each health care worker needs to understand his or her role in infection prevention and control, integrate it into daily activities, and articulate this role to others. This strategy for complying with Joint Commission standards meets customer needs and can easily be adapted for use in other medical centers. The process of defining departmental roles in the infection control program will continue to evolve with increased awareness of customer needs and emphasis on continuous quality improvement.