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HAI Rates Reduced By Transporting ICU Patients Less Often

SUMMIT, NJ --Immobilized, ventilator-dependent ICU patients are at the highest risk of hospital-acquired infections (HAIs). A New Jersey health center was able to lower the infection rate by doing less, not more.

An article published in the journal Neurocritical Care reports how fewer transports and more judicious use of catheters reduced the infection rate in those patients.

“Despite broad implementation of relevant bundles, HAI incidence in our neuro ICU remained high, particularly catheter-associated urinary tract infections (CAUTIs) and ventilator-associated events (VAEs),” reported researchers from Atlantic Health System. “We reviewed the administrative data and nosocomial infection markers (NIMs) for all neurology and cranial neurosurgery patients admitted to our neuro ICU between January 2011 and May 2014, identified and implemented interventions, and measured effects using National Healthcare Safety Network (NHSN)-defined CAUTIs and VAEs.”

Among the interventions were the following:

  • reviewing Foley catheter use, including indications and alternatives, and instituting daily rounds, continuously questioning the ongoing need for a catheter,
  • re-educating neuro ICU personnel in insertion and maintenance technique, introducing a new kit that simplified and standardized sterile insertion, and
  • placing a mobile CT in the neuro ICU, since patients required repeated transports for brain imaging and since researchers found correlations between frequencies of these transports, and both respiratory and urinary NIMS.

Results indicate that VAEs decreased 48%, Foley use decreased 46%, CAUTIs decreased from 11/1000 catheter days to 6.2. At the same time, the overall complication rate decreased 55%, ICU length of stay dropped by 1.5 days, and risk-adjusted mortality declined by 11%.

“Combining a multidisciplinary approach with rigorous analysis of objective data, we decreased total HAIs by 53% over 18 months,” study authors wrote. “Key drivers were decreased urinary catheter use and decreased patient transport from the ICU for imaging.”

“Through a rigorous analysis, we were able to pinpoint causes and take actions that, together, had a very significant impact on preventing ventilator and urinary catheter-related infections,” lead investigator John J. Halperin, MD, chair of the department of neurosciences at Overlook Medical Center, said in an Atlantic Health System press release. “Better training and limiting the use of catheters was important in this effort. But the real surprise was that transporting patients for brain imagining was a major source of the problem, and by introducing a mobile CT scanner we could substantially reduce infections.”