Mary Dixon-Woods (University of Leicester)
Intensive care units at hospitals in England sharply cut their rates of serious blood stream infections over a two-year period, according to researchers at University of Leicester and University of Birmingham in the U.K. The latest results were reported last week in the journal Implementation Science, following up on an evaluation of an infection-reduction program at 200 hospitals.
The program, called Matching Michigan and administered in the U.K. by its National Patient Safety Agency, aims at reducing blood stream infections caused by infections from central venous catheters in intensive care units. The name comes from a similar program in Michigan, where hospitals instituted changes in clinical practice, along with leadership and cultural changes to reduce central venous catheter infections.
As in Michigan, the program in the U.K. introduces a series of practices combining technical and practical enhancements, with changes in the hospitals’ leadership styles and culture to bring down the infection rates. Among the new practices are strict hand hygiene and cleaning the skin with the correct antiseptic. The changes also call for full barrier protection for clinicans, including cap, gown, gloves, and mask. In addition, the program urges clinicans to consider avoiding the groin as the place for inserting a central venous catheter, and calls for daily reviews to confirm that the patient still needs the catheter.
The evaluation, reported in September 2012, found a reduction in the number of infections by more than 60 percent. Birmingham’s Julian Bion, the lead author says the hospitals succeeded in indeed “matching Michigan,” bringing down the infection rate to that in Michigan. However, Bion also noted that the English hospitals started at an infection rate about half that of Michigan’s starting rate, and that infection rates dropped at about the same rate at hospitals not participating in the program.
A team led by Leicester medical sociologist Mary Dixon-Woods (pictured at top) followed up on the evaluation to explain some of the reasons for the program’s success or, in some cases, non-success. Dixon-Woods and colleagues interviewed staff at 19 intensive care units — 17 taking part in Matching Michigan — and observed their activities.
The team’s findings showed one hospital adopted the Matching Michigan program with enthusiasm, transforming both its practices and organizational culture. Another five institutions used the program to enhance their current practices, while 11 hospitals made few changes in their operations. The authors attribute the mixed participation to previous national policies addressing the problem that were perceived as top-down and punitive. Local conditions, previous experiences of the institutions, and quality of leadership in achieving consensus also influenced the outcomes.
While the drop in infection rates cannot be traced directly back to the Matching Michigan program, Dixon-Woods says it is still good news for patients and National Health Service staff, who she says “have been following best practice as defined internationally, and are now getting the public recognition they deserve.”
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