Hospitals will quickly slash the rate of common,
costly and potentially lethal catheter-related bloodstream
infections in their intensive care units by using cheap,
low-tech, common-sense measures like hand washing, timely
removal of unneeded catheters and use of sites other than
the groin to place lines when possible, according to a
report from safety experts at Johns Hopkins in the Dec. 28
issue of the New England Journal of Medicine.
"There's just no reason anymore not to do these
relatively simple things," said Peter Pronovost, professor
of medicine at the School of Medicine and medical director
of Johns Hopkins'
Center for
Innovation in Quality Patient Care, who led researchers
in their review of 103 Michigan ICUs before, during and
after implementing a variety of measures designed to reduce
such infections.
Nationwide, an estimated 80,000 bloodstream infections
occur each year as a result of central venous catheters,
which are tubes inserted through a blood vessel that ends
near or in the heart to deliver treatments and monitor
care. Bloodstream infections are involved in up to 28,000
deaths in the United States alone among these ICU
patients.
"A common misperception among hospital-based
clinicians is that it often costs much too much money and
time to significantly improve patient safety," Pronovost
said. "Our data destroys this myth by showing that profound
improvements can be made with minimum cost and effort as
long as clinical teams are committed to improving safety
and willing to diligently observe relatively simple safety
measures."
Economically, the toll of the infections is enormous,
Pronovost said, with an average cost to the health care
system of $45,000 per patient for treatment and billions
each year nationwide, "far more than it costs to implement
steps to prevent the infections in the first place."
In the Michigan hospital system, which served as a
pioneering pilot site for infection prevention measures,
efforts included training physicians and nurses about
infection control; using special standardized central-line
supply carts that are controlled for one-time use;
requiring use of a cockpit-style "checklist" to ensure
adherence to infection-control practices such as hand
washing; avoiding catheter placement through the femoral
artery in the groin, an area notoriously difficult to keep
sterile; using and changing gloves, gowns and masks for
each procedure; cleaning patients' skin with chlorhexidine;
and removing catheters as soon as possible, even if there's
a chance they might be needed again at some point.
The safety plan also requires immediate "stop now"
orders by any member of the health care team when a
checklist is not followed to the letter, and feedback to
each member of the care team about the number and rates of
catheter-related bloodstream infections at weekly and
quarterly meetings.
Pronovost said the study team gathered information in
Michigan representing 375,757 ICU catheter-days, collected
quarterly for up to 18 months after implementation of the
safety measures.
The results were dramatic, he said, when the steps
were implemented. The median rate of catheter-related
bloodstream infections per 1,000 catheter-days decreased
from 2.7 at baseline to 0 after implementation of the
safety measures, and the mean rate decreased from 7.7 at
baseline to 1.4 at 16 to 18 months of follow-up.
The study was funded by a grant from the Agency for
Healthcare Research and Quality.
To learn more about the work of the Center for
Innovation in Quality Patient Care at Johns Hopkins, go to
innovation.jhmi.edu/index.cfm