NYC HHC - Kings County Hospital Center

Targeting Zero In The ICU Using HIT

Kings County Hospital Center's (KCHC) program Targeting Zero In The ICU Using HIT uses electronic medical records and interventions to reduce the risk of catheter related bloodstream infections (CRBSI) and ventilator associated pneumonia (VAP). Invasive devices such as central venous catheters and mechanical ventilators are essential elements in providing intensive care to very sick patients, but these devices increase patients’ risk of developing life-threatening infections. It is estimated to cost $45,000 to treat each catheter related blood stream infection (CRBSI) and $12,000 to treat each VAP.

KCHC’s goal of maintaining zero rates of CRBSI and VAP is accomplished by their use of the electronic medical record that prompted care givers with information about “bundles” of care that should be provided for these patients, daily automated report of all bloodstream infections and radiological evidence of pneumonia, and prompt investigation for causes of these infections and interventions to prevent future nosocomial infections. The causes of spikes in VAP and CRBSI identified included poor hand hygiene, erroneous use of occlusive dressings, and incorrect use of antibiotic ointment. As these deviations were corrected, CRBSI rates went to zero. The cornerstone of the interventions included continued reinforcement of good hand hygiene to nursing staff and visitors. Residents were also oriented on each monthly tour and daily during rounds to strict hand hygiene policies. During the period between December 2007 and June 2009, KCHC did not have a single episode of CRBSI in their surgical ICU. This was a direct result of implementing the ventilator bundle.