title: Reducing Hospital-Acquired Infections Among the Neurologically Critically Ill.
abstract: Hospital-acquired infections (HAIs) result in excess morbidity, mortality, and resource consumption. Immobilized, ventilator-dependent ICU patients are at the highest risk of HAI.
  
  
  
  Despite broad implementation of relevant bundles, HAI incidence in our neuro ICU remained high, particularly catheter-associated urinary tract infections (CAUTIs) and ventilator-associated events (VAEs). We reviewed the administrative data and nosocomial infection markers (NIMs) for all neurology and cranial neurosurgery patients admitted to our neuro ICU between January 2011 and May 2014, identified and implemented interventions, and measured effects using National Healthcare Safety Network (NHSN)-defined CAUTIs and VAEs. Interventions included (1) reviewing Foley catheter use, including indications and alternatives, and instituting daily rounds, continuously questioning the ongoing need for a catheter; (2) re-educating neuro ICU personnel in insertion and maintenance technique, introducing a new kit that simplified and standardized sterile insertion; and (3) placing a mobile CT in the neuro ICU since our patients required repeated transports for brain imaging and since we found correlations between frequencies of these transports, and both respiratory and urinary NIMS.
  
  
  
  VAEs decreased 48 %, Foley use decreased 46 %, CAUTIs decreased from 11/1000 catheter days to 6.2. Overall complication rate decreased 55 %, ICU length of stay 1.5 days, and risk-adjusted mortality 11 %.
  
  
  
  Combining a multidisciplinary approach with rigorous analysis of objective data, we decreased total HAIs by 53 % over 18 months. Key drivers were decreased urinary catheter use and decreased patient transport from the ICU for imaging.
authors.affiliation: Department of Neurosciences, Overlook Medical Center, 99 Beauvoir Avenue, Summit, NJ, 07902, USA. john.halperin@atlantichealth.org.|Atlantic Health System, Morristown, NJ, USA. john.halperin@atlantichealth.org.
authors.forename: John J
authors.identifier: 0000-0003-1170-1710
authors.initials: JJ
authors.lastname: Halperin
authors.affiliation: Atlantic Health System, Morristown, NJ, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Moran
authors.affiliation: Atlantic Health System, Morristown, NJ, USA.|Overlook Medical Center, Summit, NJ, 07902, USA.
authors.forename: Doriann
authors.initials: D
authors.lastname: Prasek
authors.affiliation: Atlantic Health System, Morristown, NJ, USA.|Overlook Medical Center, Summit, NJ, 07902, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Richards
authors.affiliation: Department of Neurosciences, Overlook Medical Center, 99 Beauvoir Avenue, Summit, NJ, 07902, USA.|Atlantic Health System, Morristown, NJ, USA.
authors.forename: Charlene
authors.initials: C
authors.lastname: Ruggiero
authors.affiliation: Atlantic Health System, Morristown, NJ, USA.|Overlook Medical Center, Summit, NJ, 07902, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Maund
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000517:prevention & control*; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000628:therapy*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D020521:Stroke / Q000628:therapy*
keywords: CAUTI; Hospital-acquired infections; Neurocritical care; Reduction; Ventilator-associated events