Lack of concern by American hospital administrators results in deadly yet easily preventable bloodstream infections each year, according to a survey of medical professionals released this week.
An estimated 80,000 patients per year develop catheter-related bloodstream infections, or CRBSIs — which can occur when tubes that are inserted into a vein to monitor blood flow or deliver medication and nutrients are improperly prepared or left in longer than necessary. About 30,000 patients die as a result, according to the Centers for Disease Control and Prevention, accounting for nearly a third of annual deaths from hospital-acquired infections in the United States.
Yet the survey, which was conducted by the Association for Professionals in Infection Control and Epidemiology and funded by Bard Access Systems, a maker of catheters, suggests hospital workers could all but eliminate CRBSIs by following a five-step checklist that is stunningly simple: (1) Wash hands with soap; (2) clean patient’s skin with an effective antiseptic; (3) place sterile drapes over the entire patient; (4) wear a sterile mask, hat, gown and gloves; (5) put a sterile dressing over the catheter site.
The methodology also calls for clinicians to routinely evaluate whether the benefits of keeping the catheter in outweigh the risks. The use of electronic monitoring systems that allow care providers to spot infections quickly and assemble a rapid response team to treat them is also urged.
A federally funded program implementing these measures in intensive-care units in Michigan hospitals reduced the incidence of CRBSIs by two-thirds, saving more than 1,500 lives and $200 million in the first 18 months. Similar initiatives across the country helped bring the overall national rate of these and related bloodstream infections down by 18 percent in the first six months of 2010, according to the CDC.
Studies indicate that the cost of implementation is about $3,000 per patient while an infection costs between $30,000 to $36,000. For a hospital, the average savings is about $1 million annually.
So why haven’t hospitals universally adopted these best practices? The survey identified ignorance and neglect by top decision-makers. More than half of the 2,075 respondents, most of whom were infection control nurses employed by hospitals, reported that they use a cumbersome paper-based system for tracking patients’ conditions that makes it difficult to promptly spot infections in real time. Seven in 10 said they are not given enough time to train other hospital workers on proper procedures. Nearly a third said enforcing best practice guidelines was their greatest challenge, and one in five said administrators were not willing to spend the necessary money to prevent CRBSIs.
Hospital leaders must take the lead in establishing a culture of infection prevention, by ensuring that care team members follow the checklist when inserting catheters, physicians are provided antiseptic soaps as part of their catheter kits and infection control personnel are provided the best tools to monitor patients.
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