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A Quality Improvement Strategy to Reduce Infection Rates

An estimated 80,000 patients each year experience catheter-related bloodstream infections during treatment in hospitals, about 31,000 of whom die, and the cost of treating these infections may be as high as $3 billion nationally. In 2009, the United States Department of Health and Human Services called for a 50% reduction in catheter-related infections nationwide by 2012. Institutions throughout the U.S. have initiated different interventions to accomplish this feat, but with varying degrees of success. Reducing Bloodstream Infection Rates Several years ago, the Keystone ICU Project was launched. Developed by Johns Hopkins University in partnership with the Michigan Hospital Association, the project utilizes a checklist for healthcare providers to follow when placing catheters. The checklist highlights five basic steps to decrease catheter-related bloodstream infection rates: 1. Promoting hand washing. 2. Full barrier precautions. 3. Skin antisepsis with chlorhexidine. 4. Avoiding the femoral site during catheter insertion. 5. Removing unnecessary catheters. Along with the checklist, the Keystone ICU Project promotes a culture of safety consisting of safety science education, training in the identification of potential safety problems, development of evidence-based solutions, and measurement of improvements. A key aspect of the program was to empower all caregivers—regardless of their level of experience—to question each other and stop procedures if safety is compromised. Profound New Data on Eliminating Infections In the January 31, 2011 issue of BMJ, my colleagues and I had a study published. It found that the virtual elimination of catheter-related bloodstream infections in ICUs throughout Michigan through the Keystone Project correlated with a 10% reduction in mortality rates in the state when compared to surrounding states. Using Medicare claims data, we...

A New Approach to Reducing the HAI Burden

The prevention of hospital-acquired infections (HAIs)—particularly bloodstream infections (BSIs) and ventilator-associated pneumonia (VAP)—has become a focus of critical care and a marker for quality among ICUs due to their significant burden. Under rules created by the CMS, a catheter-related BSI (CR-BSI) is now considered one of the preventable complications that will not be incrementally reimbursed. As a result, hospitals are more closely scrutinizing rates of HAIs and increasingly making efforts to reduce their impact. Assessing Potential Strategies In the March 2010 Archives of Surgery, my colleagues and I published a retrospective analysis of data collected 6 months before and after institution of a chlorhexidine gluconate bathing protocol in a trauma ICU. Chlorhexidine is an antiseptic preparation that has demonstrated broad activity against yeasts, viruses, and bacteria (including multi-drug resistant organisms, such as MRSA and Acinetobacter baumannii). The study compared the efficacy of daily bathing with washcloths impregnated with 2% chlorhexidine with that of disposable washcloths without this substance to determine the effect on HAI rates as well as its effect on the rate of isolation of multidrug-resistant organisms. “Using routine decontamination bathing regimens may help decrease the potential for organism transmission.” We observed that introduction of 2% chlorhexidine gluconate to routine, daily whole-body bathing of trauma ICU patients was associated with a significant reduction in the incidence of CR-BSIs. While the incidence of VAP was not significantly affected by chlorhexidine baths, patients who received these baths were less likely to develop MRSA VAP. The rate of colonization with MRSA and Acinetobacter was significantly lower in the chlorhexidine group than in the comparison group. The intervention also appeared to change...
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