CLABSI: 'A Polio Campaign for the 21st Century'

Just before the long weekend, health providers heard some upbeat news, a fine respite from all the gloom about the sustainable growth rate and healthcare reform politics. In fact, infection control officials who attended a briefing almost sounded like they were attending a pep rally and not a press conference.

That's because it isn't every day that a federal agency can boast an 18% cut in dreaded CLABSI, or central line associated bloodstream infections, which occur an estimated 248,000 times each year in U.S. hospitals. These usually preventable infections cost the healthcare system $2.7 billion annually, and are said to be the cause of between 31,000 and 60,000 hospital deaths a year.

The good cheer was presented in the form of a document from the Centers for Disease Control and Prevention entitled the "First State-Specific Healthcare-Associated Infections Summary Data Report," an 18-page summary that examined the occurrence of these types of infections in hospitals during the first six months of 2009. What the project found was that there was a dramatic drop in CLABSI compared with the previous three years. The findings paralleled earlier reports, but included a much larger and more diverse sample of hospitals.

"We believe this decrease reflects broader implementation of CDC guidelines, enhanced tracking and measurement, and improved practices at the local level by thousands of dedicated healthcare professionals," said Arjun Srinivasan, MD, the CDC's associate director for Healthcare-Associated Infection Programs.

If there was a caveat about their sense of accomplishment, it was that the results were from a collection of data from just 17 states, which as of June 30, 2007 were the ones with laws requiring CLABSI reporting to the CDC's National Health Care Safety Network. About 10 more states have since enacted reporting mandates for these infections, but clearly what infection control leaders want is for all 50 states to have them in place. That's so they can have all the data to serve as a benchmark for future improvement.

This report included information from 1,538 facilities in those 17 states: Colorado, Connecticut, Delaware, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Vermont, Virginia and Washington. Only Tennessee and Maryland had infection ratios above expectations. Of the 15 states, 13 had fewer than expected instances and two had rates as expected. All rates were calculated based on a rate per 1,000 line days.

According to a table in the report, states that did not have reporting requirements had some hospitals that did report to the network, but in none of those non-reporting states was the number of reporting hospitals more than half. That will have to rapidly change, the researchers say.

One of the speakers at the briefing was Peter Pronovost, MD, an intensivist at Johns Hopkins University whose simple infection control "checklist" has been credited with getting many of those states' infection rates to drop. In fact, surgeon Atul Gawande reportedly credited Pronovost with "saving more lives than that of any laboratory scientist in the past decade."

The report "marks a turning point in transparency and accountability for healthcare," Pronovost said. "We now must begin to be responsible for our outcomes and no doubt these data will make some uncomfortable. We need to learn how to be accountable; to make progress we will need to collaborate and (be) coordinated."

"Central line associated bloodstream infections are the polio campaign for the 21st century," he added.

Pronovost, director of the division of adult critical care medicine at Johns Hopkins and medical director of the Center for Innovations in Quality Patient Care, pointed to the tremendous success he and infection control officials at Johns Hopkins University and at 100 intensive care units in Michigan were able to achieve by following these five steps.

• Remove unnecessary lines.
• Wash hands prior to procedure.
• Use maximal barrier precautions.
• Clean skin with chlorhexidine.
• Avoid femoral lines.

He added that a key element to make that checklist work is that hospitals must "empower nurses to sop the placement of a catheter if the physicians don't comply with the checklist.