GO

The Bug Club


Program Overview

"The Bug Club" Northshore Collaborative to Prevent and Treat Healthcare-Associated Infections was founded to improve the rate of coronary artery bypass graft (CABG) infections at five Northshore hospitals in the New Orleans metro area. The mission was to create a collaborative approach to implement evidence-based infection prevention practices among the hospitals who shared the same group of cardiovascular surgeons.

Objectives
  • To decrease CABG surgical site infections
  • To prevent and reduce multidrug-resistant organism colonization and infection
Solutions

The strategies that the Northshore Collaborative embraced to achieve their objective of reducing infections were centered on a disciplined sharing of best practices. The multidisciplinary team was devoted to enhancing the prevention and treatment of healthcare infection by sharing expertise throughout the continuum of care.

The concept provided a forum to address infectious disease concerns at the local level. The effort was intended to promote specific best practices not only for preventing, but also for treating infection in patients, including interventions designed to ensure that hospitalized patients receive the right antibiotic, at the right dose, at the right time, and for the right duration. The first “Bug Club” meeting took place in February 2008 and included infectious disease physicians, infection preventionists, and clinical pharmacists from each of the five hospitals. In preparation for the meeting, participants were asked to research best practices to prevent CABG infections. The group met several times over the next four months to review and discuss the research findings and to formulate and finalize best practices.

The group developed the following best practices:

  • Methicillin-resistant Staphylococcus aureus (MRSA) active surveillance
  • Pre-op showers (the night before and morning of surgery with chlorhexidine gluconate known as CHG)
  • CHG wipe protocol (wiping entire patient with CHG wipes one hour after the morning shower and each morning for three days post-operation)
  • Decolonization protocols for patients who test positive for MRSA (mupirocin ointment placed into each nostril twice a day and chlorhexidine mouthwash used four times a day for five days)
  • Weight-based prophylactic antibiotic dosing for cefazolin and vancomycin
  • Prophylactic antibiotics for patients positive for MRSA and for patients allergic to penicillin or cephalosporins
  • Adherence to Surgical Care Improvement Project (SCIP) guidelines

Once the set of best practice protocols had been approved by all “Bug Club” members, including the cardiovascular surgeons, each hospital presented the order sets to the medical staff community for approval. In addition, education was provided to the nursing staff, including posters placed in common areas.

Outcomes

The "The Bug Club" Northshore Collaborative program was a success, with all five hospitals experiencing at least a 70 percent reduction in the incidence of CABG surgical site infections over two years.

Overall CABG Surgical Site Infection Rates Between 2007-2009

YearHospital AHospital BHospital CHospital DHospital E
2007 5.4% 4.8% 3.5% 7.2% 1.8%
2008 4.1% 2.9% 5.3% 3.5% 1.5%
2009 1.2% 0.7% 0.0% 1.4% 0.5%
2010 1.3% 0.8% 0.0% 0.8% 0.9%

The collaborative reported key lessons learned from the effort: The positive results generated helped turn what was initially a facility and physician competition into a productive collaboration. Including education on new and innovative patient care practices improved attendance at meetings. To roll out the new best practices effectively, order sets should be interwoven into individual physician order sets for better compliance.