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Research News: Prevention of Central Line-Associated Bloodstream Infections
Debra: AHRQ is funding a new project to test methods for reducing central
line-associated bloodstream infections in hospital intensive care units.
Hospital associations and patient safety groups in 10 states will be involved in
the project. With us to talk about this effort is Dr. Peter Pronovost from the
Johns Hopkins University Quality and Safety Research Group. Dr. Pronovost is
also co-principal investigator on the project. Welcome.
Dr. Pronovost: Thank you.
Debra: Let’s start big picture. What are central line-associated
bloodstream infections?
Dr. Pronovost: Well, central lines, or central venous catheters, are
tubes that are placed into the large veins in a patient’s neck, sometimes in the
chest or groin, to administer medication or fluids, or to collect blood samples
while patients are hospitalized. Typically sicker patients are the ones who get
these. By definition, bloodstream infections are considered to be associated
with a central line if it was in use during the 48-hour period before a
bloodstream infection develops.
Debra: So is this a major issue in our hospitals today?
Dr. Pronovost: It really is. These infections are common, costly, and
often lethal. Research shows that there are about 250,000 cases of central
line-associated infections in US hospitals every year. These infections are also
very costly in terms of lives and dollars. At least 30,000 patients who get a
central line-associated bloodstream infection die each year, and the average
hospital cost for each of these infections is more than $36,000.
Debra: So how can clinicians reduce the risks to their patients?
Dr. Pronovost: Much could be done to prevent these infections. Proper
placement of the central line is critical. Also, clinicians can greatly reduce
the risk of spreading germs by always washing their hands before and after the
procedure, and by wearing a hat, mask, sterile gown and gloves. There’s also a
soap called Chlorhexidine that reduces infection, and importantly, that they
take out these catheters when they’re no longer needed.
Debra: Let’s talk about the AHRQ-funded project. Who’s taking part, and
what are you hoping to achieve?
Dr. Pronovost: Well this is an exciting project that ultimately, our goal
is to reduce the average rate of central line-associated blood stream infections
across the US in all hospitals by 80 percent. Right now, the national average is
five infections per 1,000 catheter days, and we want to get that down to less
than one per 1,000 catheter days. The project involves 10 states: California,
Colorado, Florida, Massachusetts, Nebraska, North Carolina, Ohio, Pennsylvania,
Texas, and Washington.
Debra: How do you hope to achieve that very large goal?
Dr. Pronovost: Well, one of the things we learned is that no one group
can do this alone. It has to be a team effort, so we’ll be participating with
hospitals to implement a checklist that ensures that patients receive the
evidence-based practices that they’re supposed to, and that staff use those
practices. However, using a checklist is only a beginning. Hospitals will have
to educate staff about exactly what they’re supposed to do. They’ll need to
monitor, in a valid way, what their infection rates are, and track those, and
we’ll have to work to create a culture of teamwork where nurses could question
physicians to make sure patients always get these evidence-based interventions.
We’re really excited to work with these diverse groups, and we have plans to
expand this project to additional participants with private funding.
Debra: And how successful do you think this project will be?
Dr. Pronovost: Well we’re extremely optimistic that we can be successful
at reducing these central-line-associated infections. We applied these tools
with great success throughout the state of Michigan. Infection rates dropped to
zero - that is, the median was zero - in over half of the hospitals that
participated in this project. There were over 103 ICUs participating. This 50
percent drop occurred within 3 months, and I believe we can see these same types
of results again. We’ve learned an awful lot about how to do it. It’s not easy,
but with diligent effort of combining evidence with valid measurement, and
culture and teamwork change, we’re confident that we could achieve these
results. And through this, not only will we save lives and dollars from these
infections, but we will put joy back into the clinicians’ lives who toil so
often at the bedside, and importantly, build national capacity to tackle one of
the many other ills that befall our health care system.
Debra: Dr. Pronovost, thank you for taking the time today to talk to us
about this project.
Dr. Pronovost: My pleasure.
Debra: To learn more about AHRQ’s patient safety research, visit
ahrq.gov/qual/errorsix.htm.
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