Tennessee Hospital Reduces Infections, Saves Lives

When Fabiola Demuth began working at Nashville General Hospital at Meharry, she looked for opportunities to improve care and eliminate healthcare-associated infections (HAI). With help from an Qsource quality improvement advisor, the hospital saw a significant reduction in central line associated blood stream infections (CLABSI) in their intensive care units (ICUs).

“After looking at all of the hospital’s recent infection data, we chose to focus on eliminating central line infections as we identified this area with the most opportunity for improvement,” says Demuth, the hospital’s infection prevention practitioner. “Blood infections can be costly and increase morbidity and mortality.”

Prevention is Possible

The Agency for Healthcare Research and Quality (AHRQ) reports healthcare-associated infections (HAIs) result in almost 100,000 deaths each year in the U.S., a third of which are caused by CLABSIs. According to the Centers for Disease Control and Prevention (CDC), an estimated 30,100 CLABSIs occur in ICUs across the country each year, with up to 250,000 occurring across various healthcare settings. The CDC reports patient mortality rates associated with CLABSIs range from 12 to 25 percent. These kinds of infections cost the nation more than $1 billion annually and the cost of one CLABSI episode is estimated to range from $3,700 to $36,000, according to the CDC.

These infections are often preventable with evidence-based infection control programs.

“We knew it was not going to be easy to reduce our CLABSIs – we needed additional resources to offer guidance,” says Demuth.

Qsource quality improvement advisor Eric Sullivan conducted an in-depth gap analysis with the CDC’s CLABSI TAP Facility Assessment Tool to evaluate the safety practices and knowledge about infections in the hospital. The assessment also established a baseline to measure improvement.

“After completing the facility assessment, I saw opportunities to standardize policies and procedures in the hospital, rally leadership around the effort to reduce infections and use data to drive decisions,” says Sullivan.

Creating Change

Sullivan advised Demuth to implement the Comprehensive Unit-based Safety Program (CUSP) model from AHRQ. The model makes care safer by improving the foundation of how physicians, nurses and other clinical team members work together.

“It combines clinical best practices with the science of safety to help the hospital address safety issues,” says Sullivan. “The CUSP model supports change at the unit level, making it modifiable and more relevant to clinicians.”

Sullivan advised the hospital staff to standardize all central line insertion kits, ensuring the same equipment every time a central line is inserted. He also assisted them with implementing a checklist for central line insertion compliance. This empowers the staff to speak up if the checklist is not completed, reducing the chances for infections during an insertion procedure or maintenance check.

“I recommended the staff bundle common care elements like dressing changes and IV fluid changes together to reduce the number of times that the central line is touched each day,” Sullivan explains.

Sullivan suggested the hospital leadership begin making rounds, just like doctors. This practice builds relationships between senior leaders, unit leaders and front-line staff. It allows leadership to address concerns, celebrate accomplishments and stay in touch with the day-to-day activities of the hospital. In this instance, it fostered support and buy-in for the CLABSI reduction effort from the hospital’s upper management.

Central line infections were the focus of a recent skills training for the hospital staff, says Demuth. “Preventing infections has to stay in the forefront. We talk about it every day.”

Demuth says Sullivan was critical to the successful reduction in CLABSIs for the hospital. “He is very invested in our success. He didn’t just show up to complete the facility assessment; he followed up with an in-depth report and guided us through changes with resources.”

Sullivan attended the hospital’s monthly infection prevention committee meeting and often visited the facility.

Together, Demuth and Sullivan converted evidence-based best practices into behavior changes that were standardized throughout the ICUs. They empowered front-line staff to identify and fix things that impair safety by involving managers and senior leadership in the changes.

Aiming for Zero

Demuth reports that as a result of the concentrated effort to eliminate CLABSI in the hospital, they reduced the standard infection ratio1 in their ICUs from 3.3 in 2015 to .5 in the first three quarters of 2016. In less than two years, Nashville General Hospital went from seven patients being diagnosed with a CLABSI to only one patient with that kind of infection.

Demuth estimates the reduction in infection episodes has saved the healthcare system approximately $160,000 since the beginning of 2016.

“We are proud of the progress we’ve made, but it is a nonstop process of improvement and monitoring. We will continue our efforts until no patients in our facility suffer from CLABSIs. We’re aiming for zero.”

Looking Forward

“A reduction in the CLABSI rate means a safer environment and improved outcomes for the patients,” says Demuth. Shorter hospitals stays, reduced readmissions and reduced risk for other types of infections are all benefits of the staff’s hard work.

Demuth says the hospital intends to spread the knowledge and insight they’ve gained from the past year and a half to prevent other types of HAIs like surgical site infections in the near future.



1. Healthcare-associated infections are reported using a standardized infection ratio (SIR). This calculation compares the number of infections in a hospital to a national benchmark based on data reported to National Healthcare Safety Network (NHSN). Lower numbers are better. A score of zero – meaning no infections – is best.