A US pilot study suggests that training staff to stick to basic hygiene measures like routine handwashing and following inexpensive, common sense guidelines, could reduce catheter-related blood infections in the ICU by up to 66 per cent.
The study is published in today’s issue of the New England Journal of Medicine and was led by a team from John Hopkins University, Baltimore.
According to the researchers, “background” catheter-related infections are costly, potentially lethal and surprisingly common in ICUs, responsible for nearly 80,000 infections and 28,000 deaths a year in the US alone. The costs are between 12,000 and 54,000 dollars per infection with an average cost of 45,000 dollars per patient.
36m patients a year in the US undergo a total of 164 million days of acute care in the US, 11 per cent of which (18m days) are spent in ICUs. For over half of the time spent in ICUs (54 per cent, 9.7m days), patients are infused with medication and fluids via central venous catheters – surgical tubes inserted into the large veins of the neck, groin or chest. The time spent with a catheter inserted is known as “catheter-days” – an important unit of measurement in these types of studies.
The most common catheter-related blood infections are by pathogens such as coagulase-negative staphylococci, staphylococcus aureus, enterococcus and candida species.
The pilot programme was conducted in Michigan and involved some 100 ICUs. The study was part of a state-wide initiative called the “Michigan Health and Hospital Association (MHA) Keystone ICU project”.
During the 18 months of the pilot, the researchers compared the data from before the “intervention” with data taken at 3 month intervals afterwards. The intervention involved training doctors and nurses in infection control according to the
The NNIS system effectively emphasises, among other things, rigorous adherence to a checklist of infection control measures such as controlled use of equipment, routine hand washing between patients, removing unwanted catheters, and avoiding inserting catheters in places that are difficult to keep clean, such as in the femoral artery near the groin.
The data came from 103 of the 108 participating ICUs, covered 1,981 ICU-months and 375,757 catheter-days. Two main results emerged. First the median rate of catheter-related infection per 1000 catheter-days went down from 2.7 infections to 0 three months after the training. The second showed that the average rate per 1000 catheter-days went down from 7.7 before the training to 1.4 some 16 to 18 months later. Using a statistical regression model, the scientists confirmed that the decrease in infection rates was sustained over the 18 month period.
From these results they concluded that a large and sustained reduction in catheter-related blood infections, as much as 66 per cent, is achievable by improving training and procedures in this area of acute care.
“An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU.”
Peter Pronovost, M.D., Ph.D., Dale Needham, M.D., Ph.D., Sean Berenholtz, M.D., David Sinopoli, M.P.H., M.B.A., Haitao Chu, M.D., Ph.D., Sara Cosgrove, M.D., Bryan Sexton, Ph.D., Robert Hyzy, M.D., Robert Welsh, M.D., Gary Roth, M.D., Joseph Bander, M.D., John Kepros, M.D., and Christine Goeschel, R.N., M.P.A.
NEJM Volume 355:2725-2732, December 28, 2006, Number 26
Written by: Catharine Paddock
Writer: Medical News Today