Major New Study Works to Reduce Central Line Infections
Huguley Memorial Medical Center (Fort Worth, TX) will play a pivotal part in a major new study that could dramatically reduce the number and severity of central line associated bloodstream infections.
A central line is a catheter placed into a large vein so a patient can be given repeated medicine or fluids or have their cardiovascular system more carefully monitored, and these lines are a regular feature in intensive care units, where patients may be recovering from serious surgery or illness.
These bloodstream infections significantly impact how long people stay in ICUs due to secondary illness, which cost patients their lives--and cost millions of dollars per year to treat. The Centers for Disease Control and Prevention estimate that around 16,000 patients per year get central line-associated bloodstream infections.
According to the article:
"The study could help eliminate a major problem for hospitals and patients, according to Huguley officials.
“It’s profound,” said Christine Sammer, the patient safety officer and administrative director of patient safety and quality at the hospital.
The study, which is being done in partnership with the Johns Hopkins Quality and Safety Research Group, will be completed by September 2008. Thirty-six other hospitals in the Adventist Health System, of which Huguley is a member, will also participate.
The study comes on the heels of the Michigan Keystone Project, which determined that facilities with an emphasis on standardized techniques and practices in ICUs helped eliminate central line infections, Sammer said. This new study will help tease out the factors contributing to the results of the Keystone Project, she said.
“This is a causal study — they saw that there was a correlation between the culture of safety and a decrease in central line infections, and now they’re looking for the cause,” Sammer said.
Since many patients have their immune systems weakened from whatever has landed them in the ICU, or from drugs used to treat their ailment, opportunistic bacteria can get into a patient’s body through a central line and cause infections that can kill.
Gayla Miles, a faculty member at UT-Arlington’s School of Nursing who teaches and studies critical care, said the lines can get infected if a patient drools or vomits near the line, which is often put in the chest. The proximity to the chest can also be dangerous because an infection will be near the heart, lungs and central nervous system.
“It’s really a needed thing, you just need to be careful,” Miles said.
Studies found that anywhere from 500 to 4,000 patients die annually from these infections, and they can cost anywhere between about $28,000 to $56,000 to treat per infection.
“We know that when a patient has a central line infection, that the charges are going to go up,” Sammer said. “Caring for that, your length of stay goes up, so your charges go up.”
Annually, the infections can cost $60 million to $460 million nationally to fight, according to information from the Johns Hopkins Quality and Safety Research Group.
Huguley Memorial, located in Burleson, which has a total of 20 ICU beds, will be asked to implement interventions to ward off infections and send in data monthly, documenting factors in the ICUs.
Sammer said that these other factors, which include how many registered nurses are present in the ICUs, how much experience health care workers have, how long patients spend in the ICUs and other information, contribute to a culture of safety, something which is just now being studied in hospitals.
Some interventions used to ward off infections of central lines include using hand hygiene, using a certain type of antisepsis to clean the skin, and avoiding femoral lines if possible. Femoral lines are put in near the groin, and keeping these areas bacteria-free can be harder to do, Sammer said.
Additionally, ICU staff are to take out unnecessary central lines and carefully document if a line looks like it may be getting infected, so the infection can be stopped early. Maximum physical barriers are also called for; while it’s normal for a nurse to use gloves, for example, he or she should also use a face mask, hair net, gown and drape the patient.
Most of the precautions are already taken in ICUs, Sammer said, but this study will take into account what happens when all of the precautions are followed 100 percent of the time.
Having more data about ICU practices and how they are affected by a culture of safety is the first step to improving patient care, Sammer said.
“Knowing that we can actually improve patient outcomes — it’s very exciting,” she said."
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