The Asian Hospital Management Awards 2007

Bangkok Hospital Medical Center is honored to be recognized from The Asian Hospital Management Award 2007 in Patient Safety / Quality Medical Care Project, this award is for the hospital that introduced an outstanding project for the monitoring and improvement in the delivery of quality medical care. Projects for the reporting, deliberation, management and prevention of Sentinel Events are included as part of this category at Dusit Resort Pattaya, Thailand on August 31, 2007.

This prestigious "Asian Hospital Management Award 2007" is presented by Options Information Company in cooperation with The International Hospital Federation / Joint Commission International / Minister of Commerce / Faber Group Berhad / Johns Hopkins Medicine International; with special participation from The Summa Foundation, to support hospitals in the Asia-Pacific Region for the delivery of affordable helth servies and products.

The Awards represent Bangkok Hospital Medical Center continuing endeavors toward quality healthcare management and serves, as an encouragement to spur us onto greater heights in our service to our patients.

Prevention of Catheter Related Blood Stream Infection

Objective:

Catheter Related Blood Stream Infection (CRBSI) is one of the major health-care associated infections. This disease contributes to the hospital’s morbidity and mortality rate. Antibiotic therapy is associated with patient side effects and can be costly. Surely, prevention of CRBSI should be the goal.

In 2002 the CDC in the United States recommended practice guidelines for prevention of intravascular device-related infection. This study evaluates our current practice before and after implementation of the new guidelines.

Activity:

1. Review CDC practice Guideline
2. Perform Gap Analysis
3. Develop revised BMC policy
4. Training and education of clinical staff
5. Implementation
6. Monitor – process and outcome

Improvement in Practice:

Pictures of:

• Suture set vs. CRBSI set
• Small drape vs. large drape
• 2% chlorhexidine in 70% alcohol for standard skin preparation instead of 10% providone iodine
• Daily catheter site care managed by a 7-color-day sticker system
• Post revised policy poster on clinical units
• Graph demonstrating reduction in CRBSI rate

Results:

During 2004 the average CRBSI rate was 10/1000 catheter days compared to the reported NNIS rate of 5.3/1000 catheter days. A Gap Analysis illustrated our areas for improvement: use of maximal personnel protective equipment (PPE), antiseptic for skin preparation available was 10% providone-iodine solution, and there was no standard schedule for catheter care.

Before implementation of the new guidelines, we planned training and education for physicians and nurses and we prepared the new central line set-up to include PPE e.g. cap, mask, sterile gloves and gown and a large skin drape. Pharmacy provided 2% chlorhexidine in 70% alcohol for standard skin preparation instead of 10% providone iodine. For daily catheter site care a 7-color-day sticker system was developed to define start and expired date that easy for nursing to monitor. Finally; hand hygiene was promoted during the study period.

Catheter Related Blood Stream Infection / 1,000 cath-day 2004-2006

Since the new guidelines have been implemented, the CRBSI rate during 2005 revealed a significantly declined CRBSI rate of 2.07/1000 catheter-days and and in 2006 the rate has continued to drop to1.15 /1000 catheter-days.

Conclusion:

CRBSI rate in Bangkok Hospital has been significantly reduced after we have implemented the new CDC guideline for prevention intravascular device-related infection. The program’s success was the result of cooperation between physicians, nurses and the support team.