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Hospitals greet success with preventing bloodstream infections-- by Robin Walters, R.N., B.S.N.

As part of our guest contributor program, we thank Robin Walters R.N., B.S.N, for her article below that examines how hospitals are working to prevent bloodstream infections. Be sure to also read Robin's other contribution on hand-washing compliance right here.

Central venous catheter-related bloodstream infections (CR-BSIs) remain among the most common types of healthcare-associated infections and could be costing U.S. hospitals well over $2 billion annually. In the intensive care unit (ICU), the national average rate for these infections is 5.3 per 1,000 catheter days, but some hospitals have reduced their rates, even drastically.

At UCLA Medical Center, concerns about rising rates of CR-BSIs in the medical ICU led to the implementation of new facility guidelines for central venous catheter care and unique strategies to promote compliance. Nurses were given scripted coaching to help them talk with both physicians and coworkers to support use of the new guidelines and were empowered to facilitate proper procedures as they assist physicians in inserting central venous catheters. Subsequently, by 2007, the CR-BSI rates had declined from 7.5 to 2.9 per 1000 catheter days in one unit and from 10.4 to 0 per 1000 catheter days in another.

CR-BSI rates in the ICU at Rochester General Hospital, NY, were well below national benchmarks, but they were on the rise in the non-ICU settings and had reached 6.9 per 1000 catheter days in 2002. Together, the nursing director and the clinical leader of the peripherally inserted central catheter (PICC) team got creative with the budget to expand the role of the PICC team to manage central venous catheters in the general patient areas. A cost benefit analysis supported this change, which was enacted with other measures, and by 2005 the hospital CR-BSI rate had dropped to 1.9 per 1000 catheter days.

Much success in lowering CR-BSI rates has come from using evidence-based prevention strategies, such as those in the Institute for Healthcare Improvement’s Central Line Bundle. And, hospitals that significantly reduced their central venous CR-BSI rates report that the following have also been instrumental: monitoring progress through ongoing data collection, providing routine feedback to patient units, physicians and hospital leaders, and receiving support from hospital leaders.

To find out what fostered the adoption of the most important CR-BSI prevention measures, Mayo Clinic researchers surveyed in 2005 a sampling of hospital infection control coordinators. The results suggest that to improve compliance with these measures, hospitals can start to promote a “culture of safety,” support infection control professional certification and take part in infection prevention collaboratives such as the 5 Million Lives Campaign and the National Healthcare Safety Network.

About the author: Robin Walters, R.N., B.S.N., has been privileged to provide care in hospitals, clinics, schools and physician offices, at sites ranging from large urban to remote rural.

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