Program reduces central line infections by 50%

Hospitals reduce their liability

A concerted effort to standardize the way central lines are introduced has reduced infections by 50% and resulted in nearly perfect adherence to evidence-based practices at 10 hospitals in the Cincinnati area, which the project leaders say will lead to dramatic reductions in cost and potential liability.

The effort was led by the Greater Cincinnati Patient Safety ICU Collaborative and primary investigator Marta Render, MD. Render is director of the Cincinnati Department of Veterans Affairs Getting at Patient Safety (GAPS) Center. She says patient safety was the primary reason for decreasing central line infections but that the potential cost savings are tremendous.

"As many as 60% of the 150,000 catheter-related, bloodstream infections that occur in the U.S. annually are thought to be preventable," Render says. Reduction in infections would not only reduce patient injury, but also result in considerable savings to hospitals, she says.

The collaborative is conducting an economic analysis of the results, but Render says any hospital easily can see the potential for savings. The cost of a central line infection is estimated at $6,000-$24,000 per case, she says, so any significant reduction in the infection rate will yield dramatic savings. The cost to the hospitals is about $12 per central line to cover to the supplies called for in the collaborative's protocol, and each hospital spent about $35,000 per year on that change.

"So if you prevent two central line infections, you make up that cost to the organization, and that doesn't include the cost to the patient, which is huge," she says. Render is looking at savings in liability costs as well, and she suspects there have to be major savings there because the evidence-based practices they employ are now the standard of care. "If you're not doing it this way, it's easy for an attorney to ask why you're not," she says.

The two-year project recently won the Ernest Amory Codman Award from the Joint Commission on Accreditation of Healthcare Organizations. The Greater Cincinnati Patient Safety ICU Collaborative was recognized for using evidence-based practices to improve patient safety. The effort to reduce health care-acquired infections for patients in the operating room and intensive care units resulted in a 50% decrease in central-line infections, and they increased adherence to evidence-based practices to 95%, from 30% before the initiative.

Suzanne Brungs, project coordinator, says some of the participating hospitals went 26 months without a central line infection. The core of the project was encouraging hospitals to use the evidence-based practices that have been proven in the literature to prevent central line infections. Strategies included reducing central-line infections by standardizing the use of sterile barriers such as gloves, gowns, full-size bed drapes, and applying antiseptic to the insertion site; reducing surgical site infections by using correct antibiotic timing; and training staff in high-risk units in organizational change methodology.

For example, hospitals were encouraged to use chorhexadine to clean the skin instead of povidone-iodine (Betadine) and to use a full-body drape on the patient instead of the small drape that comes with most central line kits.

The Greater Cincinnati Patient Safety ICU Collaborative was funded in part by the Agency for Healthcare Research and Quality. (Render urges Healthcare Risk Management readers to go to http://www.gapscenter.va.gov/gapscenter/CLP.asp for more information on the initiative and materials for implementing a similar program.)

"If we could do it here in these hospitals, I don't see any reason that other hospitals couldn't get the same results," she says. "These hospitals represented rural hospitals, teaching facilities, a wide variety of facilities with varying resources available to them."

Sources

For more information on reducing central line infections, contact:

  • Suzanne Brungs, Project Coordinator, GAPS Center, Cincinnati Department of Veterans Affairs, Cincinnati VA Medical Center, 3200 Vine St., ML 111, Cincinnati, OH 45220. Telephone: (513) 475-6366. E-mail: suzanne.brungs@med.va.gov.
  • Marta Render, Director, GAPS Center, Cincinnati Department of Veterans Affairs, Cincinnati VA Medical Center, 3200 Vine St., ML 111, Cincinnati, OH 45220. Telephone: (513) 475-6366. E-mail: Marta.Render@med.va.gov.