Intensive-care units have seen their rates of central line-associated bloodstream infections drop significantly, according to a report from the Centers for Disease Control and Prevention. But other healthcare settings, such as outpatient dialysis clinics, which showed less improvement in reducing such infections, are working hard to achieve similar successes.
ICU infections decrease
But numbers aren't as positive in other settings
“The data shows that a tremendous amount of progress has been made in preventing these infections,” said Dr. Arjun Srinivasan, associate director for healthcare-associated infection prevention programs in the CDC's Division of Healthcare Quality Promotion. “It shows us that large reductions are possible, and it helps us to know the areas where more work is needed.”
The numbers of central-line associated bloodstream infections among ICU patients fell 58%, from 43,000 in 2001 to 18,000 in 2009, according to the March 1 report. The improvement saved 27,000 lives and $1.8 billion in excess healthcare costs, the CDC said in a news release.
Srinivasan credits the improvement in ICUs to a number of factors. First, he said, initiatives such as On the CUSP: Stop HAIs—CUSP stands for Comprehensive Unit-Based Safety Program—have taken complex clinical guidelines and distilled them into five or six easy-to-follow key practices.
The On the CUSP program is based on the Michigan Keystone project, a successful infection-prevention initiative first rolled out in Michigan ICUs. The model is now being implemented nationally, with the help of HHS' Agency for Healthcare Research and Quality and the Health Research & Educational Trust.
Additionally, Srinivasan said, ICUs' progress in reducing rates of central-line infections has been bolstered by increased education, heightened attention from hospital leaders, and changes in staff culture.
The news was not so rosy for other settings. Approximately 37,000 central line-associated bloodstream infections occurred in hemodialysis patients in 2009, according to the report. And 23,000 more such infections occurred in non-ICU hospital wards. “The report findings point to a clear need for action beyond ICUs,” Dr. Denise Cardo, director of the CDC's Division of Healthcare Quality Promotion, said in the release.
But many of the approaches that have proven so effective in ICUs are currently being modeled in other settings, Srinivasan said. In 2009, the CDC began working with a number of organizations in a collaborative effort to improve infection-prevention rates for dialysis. Mercy Medical Center, Clinton, Iowa, was one of the first to join, said Mary Lincoln, dialysis director at the 158-bed hospital.
Protocols are different for dialysis patients than for patients in the ICU, Lincoln said. Patients are seen on an outpatient basis, so there is less control and more need for self-management education. In addition, infections in dialysis settings are often attributable to the use of central lines rather than improper insertion, which is usually the problem in intensive care.
When Mercy joined the collaborative, they were averaging one infection per month. But after working with the group and implementing recommended practices, the hospital went 12 months without a single infection, Lincoln said. The CDC recently opened up the collaborative to a second wave of participants, she added. Pamela Peterson, clinical director for critical care and dialysis at 589-bed AtlantiCare Regional Medical Center, Atlantic City, N.J., was also an early member of the CDC's collaborative and says her hospital's rates of central line-associated bloodstream infections among dialysis patients have also dropped.
Peterson said she believes the improved numbers seen in ICUs are reachable targets for dialysis clinics. “All of the group's members are focused on the same goal, and they are very motivated.”
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