Safer ICUs: Cheap, simple, 'low-tech' steps work

December 27, 2006

Hospitals will quickly slash the rate of common, costly and potentially lethal catheter-related bloodstream infections in their intensive care units (ICUs) 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 any more not to do these relatively simple things," says Peter Pronovost, M.D., professor of medicine and medical director of 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.

"A common misperception among hospital-based clinicians is that it often costs much too much money and time to significantly improve patient safety," says Pronovost. "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."

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. Economically, the toll is enormous, Pronovost says, 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 says, 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.
-end-
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 in Patient Care at Johns Hopkins, go to http://innovation.jhmi.edu/content.cfm?sectionID=33&pagedID=122

Johns Hopkins Medicine

Related Bloodstream Infections Articles from Brightsurf:

Breast cancer cells swallow a 'free lunch' of dietary fat particles from the bloodstream
A research team at Dartmouth's Norris Cotton Cancer Center has previously shown that fatty particles from the bloodstream may boost the growth of breast cancer cells.

Study suggests weight-loss surgery may release toxic compounds from fat into bloodstream
Toxic man-made chemicals -- such as polychlorinated biphenyls and organochlorine pesticides -- that are absorbed into the body and stored in fat may be released into the bloodstream during the rapid fat loss that follows bariatric surgery, according to a study from researchers at the Johns Hopkins Bloomberg School of Public Health.

A 'shocking' new way to treat infections
New research from the University of Pittsburgh's Swanson School of Engineering introduces a revolutionary treatment for these infections.

Salmonella causing bloodstream infections in central Africa resistant to nearly all drugs
The first extensively drug-resistant (XDR) strains of Salmonella Typhimurium, a pathogen which is responsible for millions of bloodstream infections per year in sub-Saharan Africa, have been identified in the Democratic Republic of Congo (DRC).

Research shows 80% drop in ICU bloodstream infections
Bloodstream infections acquired in UK Intensive Care Units (ICUs) reduced by 80% between 2007 and 2012, according to research funded by the NIHR Guy's and St Thomas' Biomedical Research Centre.

Hospital infections declining in Canada
There is good news on the infection front: infections acquired by patients in Canadian hospitals are declining, with a 30% reduction between 2009 and 2017, according to new research in CMAJ (Canadian Medical Association Journal).

Multiple concurrent central lines increases risk for bloodstream infection
A study by the Society for Healthcare Epidemiology of America demonstrates the relationship between multiple concurrent central lines and the increased risk for bloodstream infections.

An improved vaccine for bacterial meningitis and bloodstream infections
Researchers have now developed a new vaccine, a native outer membrane vesicle (NOMV) vaccine, for meningitis and bloodstream infections caused by 'meningococcal group B' bacteria.

T2Bacteria panel rapidly and accurately diagnoses common bloodstream infections
In a clinical trial, the T2Bacteria Panel showed promise for rapidly and accurately diagnosing bloodstream infections or sepsis caused by five common bacteria.

Clinical trial looks at absorption levels of sunscreen active ingredients into bloodstream
The US Food and Drug Administration recommends that active ingredients in sunscreen absorbed into the bloodstream above a certain level undergo toxicology testing.

Read More: Bloodstream Infections News and Bloodstream Infections Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.