Continuing CR-BSIs an 'accountability failure'
Continuing CR-BSIs an 'accountability failure'
APIC survey shows largely preventable infection still thriving
Despite dramatic and widely reported breakthroughs in preventing bloodstream infections, the cold truth is that too many infection preventionists labor in obscurity, their programs woefully underfunded by administrators blind to the power of prevention. In such settings, catheter-related bloodstream infections (CR-BSIs) that increasingly appear to be largely preventable besiege patients and drive up the toll in deaths and dollars.
Damning evidence to this effect came in the form of survey results released recently in New Orleans at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC). Half of those surveyed agree that CR-BSIs continue to be a problem in their facilities and cite lack of time, resources, and the commitment of hospital leadership as hindering their ability to combat these infections more aggressively.
Survey results were collected from 2,075 respondents: 1,563 are APIC members and the remainder, members of the Infusion Nurses Society and the Association for Vascular Access. For the purposes of the survey, CR-BSIs include infections resulting from central lines, peripheral lines, dialysis lines and implanted ports.
About half of survey respondents agree that they spend so much time on surveillance or reporting that they do not have time to work on CR-BSI prevention. Seven in 10 feel they do not have enough time to train others adequately on how to prevent bloodstream infections. When asked to identify the greatest challenges to implementing best practices to prevent CR-BSIs, the top answers were enforcing policies related to infection prevention and educating staff, followed by conducting surveillance for CR-BSIs using a paper-based system.
"Bloodstream infections from catheters are nearly 100% preventable with clear, actionable steps," said APIC 2010 President Cathryn Murphy, RN, PhD, CIC. "Many hospitals have seen their rates decline dramatically some have gotten to zero and have maintained that. It is disturbing that some hospitals still report having difficulty implementing best practices to avoid these infections."
An estimated 80,000 patients a year in the U.S. develop CR-BSIs, and about 30,000 die from them, accounting for roughly a third of the deaths that occur each year from HAIs. The average cost of care for a patient with this type of infection can exceed $30,000, costing the U.S. healthcare system more than $2 billion annually.
"We learned that despite everything we know and everything we do, bloodstream infections are still prevalent in American hospitals," APIC CEO Kathy Warye said at a press conference announcing the findings. "The good news is that there is increasing awareness among hospital leaders regarding bloodstream infections that they are an issue. Fifty percent of our respondents strongly believe that their administration knows the extent to which CR-BSIs are a problem. Yet there is a disconnect, as respondents perceived inadequate leadership and support to reduce these infections. Only one in four respondents strongly believe that their leaders hold staff accountable for adhering to CR-BSI past practices."
A lack of accountability
That finding in particular struck a dissonant note.
"To have 75% of the infection preventionists say that [their leaders] don't have accountability is alarming," said Peter Pronovost, MD, PhD, FCCM, lead clinical advisor to APIC on the CR-BSI initiative and professor, Johns Hopkins University School of Medicine. "It speaks to me as an accountability failure in health care."
Only three in 10 respondents strongly felt that their institutions are willing to spend the necessary money to prevent CR-BSIs, Warye added. "This is despite the fact that the interventions were pennies on the dollar in comparison to the potential savings," she said.
For example, more than 50% of respondents are still using labor-intensive paper-based surveillance systems rather than the widely available electronic system, Warye noted.
"The ability to follow data closely is an extremely important part of preventing infections," said Ami Richmond, RN, MHS, CIC, an infection preventionist at P3Healthcare Consulting in St. Louis, MO. "Electronic surveillance programs help us to track, log and prevent infections. Infection preventionists need the ability to identify a CR-BSI as soon as the culture is positive, and we must respond actively each and every time they are identified."
Formerly an IP at Barnes Jewish Hospital in St. Louis, Richmond emphasized that electronic surveillance data actually promote collaboration and teamwork.
"We began notifying our ICU as soon as we identified a CR-BSI, and we found it to truly promote collaborative relationships with our clinicians," she said. "A rapid response to each and every CR-BSI helped facilitate very important discussions between our health care staff and [infection prevention]. It brings the patient impact to the forefront and it helps to personalize the data for everyone involved."
In addition, one of the ICUs at the hospital started posting CR-BSIs in the unit, promoting accountability among the staff, she said.
"Our cardiothoracic ICU went an astonishing 18 months without a single CR-BSI," Richmond said. "This was due to strong physician and nursing leadership in that unit. They supported a culture of safety that held each other accountable for safe insertion and care of those lines. When they had their first CR-BSI after those 18 months it was devastating for the entire team."
The incidence of CR-BSI varies considerably by type of catheter, and how and when the catheter is used. Intravascular catheters are long, thin, flexible tubes inserted into a vein that lead to the heart and are used to give medication, supply nutrition, or monitor blood flow. They are used frequently in healthcare institutions, particularly in ICUs. Nearly three in 10 respondents report that improper maintenance of lines or ports is a significant cause of CR-BSIs at their facilities.Despite dramatic and widely reported breakthroughs in preventing bloodstream infections, the cold truth is that too many infection preventionists labor in obscurity, their programs woefully underfunded by administrators blind to the power of prevention.
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