The Road to Eliminating Device-Related Infections -- by Rabih O. Darouiche, M.D.

Hospital-acquired infections (HAIs) are infections resulting from treatment in a hospital or a health care service unit that are not related to the patient's original condition for which they entered the hospital.  While HAIs can come from a variety of sources, including contaminated bed sheets and dirty hands, it is critical to note that more than half of HAIs are attributed to medical devices such as central venous catheters (CVCs), bladder catheters, endotracheal tubes, tracheostomy devices and surgical implants.

To advance the fight against these infections, the Multidisciplinary Alliance Against Device-Related Infections(MADRI) conference was founded as a platform for various institutions to gather under one goal - medical device infection prevention.  Governmental agencies, health care providers, medical societies and drug- and device-manufacturing companies meet annually to provide education and promote discussion around medical interventions, surgical advances and regulatory perspectives on device-related infections.

However, one of the common difficulties for medical professionals when discussing prevention methods is how to reduce the incidence rates of infections without reducing the number of indwelling devices used.  Removing the device altogether is not always a feasible strategy, as some indwelling devices are critical to a patient's care and well-being.  With this in mind, MADRI focuses on multidisciplinary approaches for the prevention and treatment of infections associated with various types of medical devices that include a two-pronged strategy of:

1. Adhering to strict hand washing and hygiene protocols
2. Using scientifically validated, evidence-based, proven medical device innovations

CVCs are common indwelling devices and a great example of how a multi-dimensional approach can help to lower the incidence rates of infections.  According to data from the Centers for Disease Control and Prevention, the majority of serious catheter-related infections are related to CVCs, which have long been associated with bloodstream infections.  In fact, approximately 90 percent of all catheter-related bloodstream infections (CRBSIs) occur with CVCs.

Recently, simple, non-coated CVCs have evolved into highly-advanced catheters impregnated with antimicrobials.  For instance, the use of CVCs impregnated with the antibiotics minocycline and rifampin has proven to reduce greatly the incidence of CRBSIs to nearly zero.  These antimicrobial agents help to protect patients from a wide variety of bacteria that initially cause the infection.

Of course, antimicrobial-coated medical devices should always be used in conjunction with basic infection control practices to achieve the most effective outcome.  Healthcare personnel should wash hands before and after contact with each patient, always change gloves when moving from a contaminated site to a clean site on the same patient, and use full barrier sterile precautions when inserting devices such as chest tubes and central lines.

With a solid commitment and adherence to infection control best practices and innovations in medical-device technology, hospitals can significantly reduce HAI rates, lower unnecessary treatment costs and, most importantly, improve patient care.

Interested in submitting content to PatientSafetyFocus.com? Please go here to learn more.

Rabih O. Darouiche, M.D. is VA Distinguished Service Professor, Departments of Medicine (Infectious Disease Section) and Physical Medicine and Rehabilitation, and Director, Center for Prostheses Infection, Michael E. Debakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX.  He is the founder of the Multidisciplinary Alliance Against Device-Related Infections (MADRI).