As many as 28,000 patients die each year in the United
States because of catheter-related bloodstream infections,
but doctors and nurses who implement simple and inexpensive
interventions can cut the number of deaths to nearly zero,
according to a study by Johns Hopkins researchers.
"This type of improvement has never been demonstrated,
but there is no reason that ICUs across the country can't
implement these interventions to achieve similar results,"
said Sean Berenholtz, assistant professor of
anesthesiology and critical care medicine and of
surgery in the School of Medicine and lead author of
the study published in the October issue of Critical
The simple interventions — which include a
system for educating nurses and doctors about infection
control, streamlining the catheter insertion process and a
safety checklist — are believed to have prevented
more than 40 infections and eight deaths and saved nearly
$2 million in additional health care costs during the
four-year study at Johns Hopkins, Berenholtz said.
Patients in ICUs have an increased risk of bloodstream
infections because nearly half of them require catheters
— tubular medical devices usually inserted into a
blood vessel — for delivering fluids and medications
during treatment, according to Berenholtz.
The ICU researchers partnered with hospital
epidemiologists to study catheter-related infection rates
from 1998 through 2002 at two Johns Hopkins ICUs that care
for adult patients undergoing general, cardiac, transplant,
trauma, vascular and orthopedic surgery. Rates were
calculated based on the number of infections per 1,000
catheter days, defined as the number of patients with a
catheter for one day. One ICU served as a control where
patients received standard care.
In the other ICU, the researchers implemented a series
of interventions that included educating ICU staff on the
prevalence and prevention of catheter-related infections,
creating a catheter insertion cart so all necessary
equipment was readily at hand, asking doctors daily whether
catheters could be removed, requiring bedside nurses to
complete a safety checklist during catheter insertions and
empowering nurses to stop procedures if the guidelines were
not followed. They also calculated the number of infections
that were prevented as well as the potential savings in
health care costs associated with catheter infections.
During the study, the catheter-related bloodstream
infection rate in the ICU that received the intervention
decreased from 11.3 infections per 1,000 catheter days in
the first quarter of 1998 to zero infections per 1,000
catheter days in the last quarter of 2002. The rate in the
control ICU remained the same during the study period.
The researchers estimate that the new interventions
prevented 43 infections, eight deaths and $1,945,922 in
additional costs in the study ICU. The same interventions
have been applied with equally dramatic results in more
than 100 ICUs participating in collaboratives sponsored by
the VHA Inc. and the Michigan Keystone Center for Patient
Safety and Quality, according to Berenholtz.
Other authors of the study are Peter Pronovost, Pamela
Lipsett, Deborah Hobson, Karen Earsing, Jason Farley,
Shelley Milanovich, Elizabeth Garrett-Mayer, Bradford
Winters, Haya Rubin, Todd Dorman and Trish Perl. The study
was supported by the National Institutes of Health, the
Agency for Healthcare Research and Quality, and the Centers
for Disease Control and Prevention.