AUSTIN (Jan. 31, 2012) — For its efforts to reduce the incidence of ventilator-associated pneumonia, pressure ulcers and health care-acquired infections, South Texas Health System (STHS), based in Edinburg, has been honored with the Texas Hospital Association’s 2011 Bill Aston Award for Quality in the Non-Research, Non-Teaching Hospital category.

Established in 2010, the award recognizes a hospital’s measurable success in improving quality and patient outcomes through the sustained implementation of a national and/or state evidence-based patient care initiative. Gloria Vela, South Texas Health System’s director of education, and Joanne Shannon, system infection prevention coordinator, will accept the award Feb. 2 at the THA Annual Conference and Expo in Austin.

In 2008, South Texas Health System in McAllen and Edinburg treated 77 patients with ventilator-associated pneumonia at an average cost of $40,000 each. Recognizing the costs associated with health care-acquired infections, in 2009 South Texas Health System embarked on a systematic approach to reducing ventilator-associated pneumonia (VAP), later expanding its focus to reducing stage 3 and 4 pressure ulcers and hospital-acquired bloodstream infections. The results have been dramatic. The system achieved zero VAPs in the first two years, zero hospital-acquired stage 3 or 4 pressure ulcers since full implementation, and zero blood stream infections in several of its units for about two years.

Using the Lean Six Sigma approach to system improvement, STHS began a multidisciplinary team project to reduce VAP. The project ultimately proved so successful that it became a model for initiatives to reduce stage 3 and 4 hospital-acquired pressure ulcers and eliminate the potential for bloodstream infections. All three projects met or exceeded their goals and introduced processes that have become hardwired throughout the system.

Candi Constantine, RN, chief nursing officer, said the team at McAllen Medical Center (MMC) took a systematic approach to the VAP project that involved benchmarking best practice standards, measuring the baseline knowledge of MMC staff, conducting education and in-service sessions, publicizing the standards of care and conducting regular assessments. The post-test conducted following education and in-service training showed that familiarity with VAP protocols improved from 73 percent to 99 percent. While the team focused on the VAP rate in the adult intensive care unit, the VAP rates in the pediatric and neonatal ICUs also were monitored.

MMC did not experience a case of VAP in the first two years of the project, saving an estimated $3 million in health care costs. In addition, the project served as a model for reducing other common hospital-acquired conditions.

STHS next turned its attention to stage 3 and 4 hospital-acquired pressure ulcers. When the project began in 2010, STHS had a rate of 13 stage 3 and 4 pressure ulcers per 1,000 patient days, which was about even with the national benchmark. This rate included wounds that were present when patients are admitted. Treatment costs average $43,180 per patient with a pressure ulcer.

Using Lean Six Sigma principles and lessons learned from the VAP project, STHS developed an “off-loader” program that focuses on staff education, turning protocols and frequent communication. Every two hours from 8 a.m. to 8 p.m., a song that includes the words “turn” or “roll” is played overhead to remind staff to change patients’ positions. After 8 p.m., a reminder message pops up on computer screens every two hours. “Wound Care Wednesday” was adopted across the system to ensure that every patient is assessed for pressure ulcers once a week. In addition, pressure ulcer checks have become part of the admission process, leading to better documentation of existing wounds. Since the program reached full implementation in December 2010, STHS has not recorded a single hospital-acquired stage 3 or 4 pressure ulcer, resulting in an estimated annual savings of $234,500.

In its most recent initiative, STHS joined the Texas Center for Quality & Patient Safety’s On the CUSP: Stop Blood Stream Infection (BSI) initiative. CUSP is an acronym for Comprehensive United-based Safety Program. The initiative has a goal of reducing or eliminating hospital-acquired bloodstream infections in its adult, pediatric and neonatal units. STHS created a multidisciplinary team of medical, nursing, infection prevention and senior management representatives and provided a toolkit that stresses proper hand hygiene, barrier precautions, antisepsis, optimal site selection, daily review and prompt removal of unnecessary lines.

Once again, STHS provided unit-level training, communication and follow-through. “Scrub the hub” reminders have been added to monthly staff meeting agendas to continue the education process. The BSI team also recently assisted in the process of selecting and testing sterile alcohol-treated IV line caps to further aid in the prevention of BSIs – evidence, according to Constantine, that both the initiative and the team approach are firmly rooted.

The project has been a success. MMC’s neonatal ICU and Edinburg Regional Medical Center’s ICU recorded 26 months without a BSI, and McAllen Heart Hospital recorded 22 months without a BSI.

“South Texas Health System has demonstrated a strong commitment to quality improvement and produced significant results,” said Dan Stultz, M.D., FACP, FACHE, president/chief executive officer of THA. South Texas shared its success story, with a focus on the “how to” as part of THA’s Annual Conference and Expo. “This group of hospitals hopefully will encourage others across the state—and particularly in The Valley—to focus on quality improvement initiatives. The science shows us what works; the challenge is having the discipline to follow each and every step of the process on each and every patient,” he added.