Hospitals across England reduced the rate of serious bloodstream infections in intensive care units (ICUs) during a two-year programme, research has shown.
More than 200 ICUs in England participated in the National Patient
Safety Agency’s Matching Michigan programme, which aimed to bring down
infections linked to central venous catheters to the rate seen in a
landmark programme in the US state of Michigan. Reducing the number of
infections by more than 60%, the English ICUs were able to equal the low
rates seen in the US.
“This is a very impressive result,” said Professor Julian Bion of
Birmingham University, who was clinical lead for the initiative. “No
national data existed before this programme. The work showed that ICUs
were already performing well at the beginning, with half the infection
rate seen at the start of the equivalent US effort. By the end, two
thirds of the English ICUs were reporting no infections.”
Julian Bion, Professor of Intensive Care Medicine at the Birmingham University and Editorial Board Memeber of ICU Management
Intriguingly, while infection rates declined in ICUs that were in the
programme, they were also declining just as fast in ICUs that were
waiting to join the programme.
Now research conducted alongside the programme, led by Professor Mary Dixon-Woods of the University of Leicester, and funded by the independent health improvement charity the Health Foundation, has been able to identify the reasons for this.
“ICUs were already responding to the evidence of best practice in
this area and to policy pressures by the time the programme came along,”
she commented. “Simply carrying out five key practices consistently can
help control infections. Our research showed that many units had
already improved their procedures, and several showed considerable
ingenuity in making care safer for patients.”
The five practices are:
- observing strict hand hygiene;
- cleaning the
skin with the correct antiseptic;
- avoiding the groin as the route of
- using full barrier protection – cap, gown, gloves and mask;
- reviewing daily whether the patient still needs the catheter.
Though the programme did boost efforts in some ICUs, the improvements
that were occurring anyway meant that it was difficult for the
programme overall to show additional impact.
“The programme cannot take all the credit for the improvements seen,”
said Professor Bion. “But the outcome is that care is safer for
patients, and NHS staff are to be congratulated for this. The programme
has provided the foundation for establishing a clinically-led national
infection reduction system for ICUs in England.”
Professor Dixon-Woods says: “It is very pleasing that we have been
able to explain better why rates of infection are falling. The results
of the research are good news for NHS staff, who may have felt
demoralised in recent months. It shows that they have been following
best practice as defined internationally, and are now getting the public
recognition they deserve. More than that, it’s very good news for NHS
Full bibliographic information
- Bion J, Richardson A, Hibbert P, Beer J, Abrusci T, McCutcheon M, Cassidy J, Eddleston J, Gunning K, Bellingan G, Patten M, Harrison D; Matching Michigan Collaboration & Writing Committee. 'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Qual Saf. 2013 Feb;22(2):110-23 http://qualitysafety.bmj.com/content/early/2012/09/20/bmjqs-2012-001325.full
- Dixon-Woods M, Leslie M, Tarrant C, Bion J. Explaining Matching Michigan: an ethnographic study of a patient safety program. Implementation Science http://www.implementationscience.com/content/8/1/70/abstract