Using Behavioral Safety techniques, Intensive Care units reduce MRSA rates by 70% in just 9 months.

High profile British Government campaigns to reduce Hospital Acquired Infections (HAI), led the County Durham and North Tees Strategic Health Authority to trial Behavioral Safety techniques in an Intensive Care unit comprising of two intensive care wards. They specifically wanted to reduce methicillin-resistant Staphylococcus aureus (MRSA) rates. Normal methods such as patient screening on admission, isolation of infected patients, staff training, barrier nursing, etc., had some effect.

Illness attributable to MRSA is thought to increase intensive care unit stay by 8 days, hospital stay by 14 days, and the death rate by 35%. MRSA costs the British and American health care systems billions of dollars a year in extended hospital stays, additional treatment costs and infection control costs.

Buy-in
The project began with ‘buy-in’ sessions at James Cook University Hospital, Middlesbrough, with the 140 Doctors, Nurses and care staff to brainstorm the behavioral issues. A number of behaviors were identified as important surroundng quality care practices. These focused on Nursing documentation, Charting and Hand-washing.

Training
A unit project team were then trained to implement the process. This covered the underlying principles of behavioral safety, checklist development, managerial alignment, training observers, goal-setting, feedback, and data entry & analysis.

Checklist Development
The behaviors identified at the ‘buy-in’ sessions were developed into ‘Behavioral Observation Checklists’ containing specific behaviors focused on documentation, charting and hand-washing.

Process
 Fourteen hospital care assistants were trained as observers. The observers monitored their colleagues in the wards for 10-20 minutes a day for one week, to find out how well the wards were doing against the behaviors on the checklists. Each ward then set an improvement target.

Observers continued to monitor daily and gave feedback when observing people and at weekly feedback meetings. The project team followed up any corrective actions, the status of which was reported back to the workgroups. This cycle of events was repeated every 25 weeks or so.

Results
Behavior improved on average by 15 percent across the two wards in the first 6 months.

Correspondingly, MRSA rates plummeted by a stunning 70 percent. This degree of success equates to extra bed capacity value over $1,000,000 p.a.

In November 2007, the Trust was named Britain’s national ‘Acute Healthcare Organization of the Year’ by the HSJ (Health Service Journal) at an award ceremony in London.