Regular Informational Emails Help Combat Hospital Infection

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A public hospital in Florida that struggled to control antibiotic-resistant infections for almost 2 decades finally succeeded by sending regular detailed emails to hospital leaders and intensive care unit personnel.

A public hospital in Florida that struggled to control antibiotic-resistant infections for almost 2 decades finally succeeded by sending regular detailed emails to hospital leaders and intensive care unit personnel.

After employing a number of different interventions over nearly 2 decades, a public hospital in Florida finally managed to reduce endemic rates of carbapenem-resistant Acinetobacter baumannii infections through the use of weekly emails to hospital leaders, according to the results of a recent study.

In 2009 and 2010, the hospital attempted to reduce the transmission of A baumannii through a series of interventions including weekly surveillance cultures, increased environmental disinfection, contact isolation, and separation of infected patients. Despite these efforts, the number of new A baumannii infections failed to consistently decrease.

Recognizing communication as a main challenge, the medical director of infection control began sending weekly emails to the hospital leadership and the intensive care units in 2011. The emails described findings from the previous week’s interventions, including the number and location of new infections, and interpreted the results of environmental initiatives, hand culture results, and the identification of shared objects among patients. In addition, the emails provided action plans based on the data to better control transmission.

The current study, published in the May 2014 issue of the American Journal of Infection Control, analyzed the effect of the emails on the monthly rate of new acquisitions of carbapenem-resistant A baumannii among hospitalized patients. The medical and trauma intensive care units, which had the highest rates of infection, received emails each weekday and were evaluated separately.

Over 42 consecutive months of data including 1,103,900 patient-days, a total of 438 new acquisitions were identified. When the interventions were implemented from 2010 to 2011, the monthly rates did not significantly change. Rates remained high when the weekly emails were sent from January 2011 through March 2012. In the period after the email intervention, from 2012 to 2013, however, the monthly rate of transmission decreased significantly. Acquisition rates dropped from 5.13 per 10,000 patient-days at baseline to 1.93 by the end of the study. Rates also significantly decreased in the intensive care units, from 67.15 to 17.4 per 10,000 patient-days in the medical unit and from 55.9 to 14.71 per 10,000 patient-days in the trauma unit.

The emails were most likely effective due to the combination of education, communication, feedback, and peer pressure, the authors of the study argue.

“These regular highly visible communications allowed us to create a sense of accountability for new cases that unified both the leadership and providers toward the common goal of decreasing new acquisitions of carbapenem-resistant A baumannii,” they conclude.

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