Failure In Central Line Infection Prevention, Survey Says

Cheryl Clark, July 14, 2010

Only three in 10 hospital administrations are willing to spend what's necessary to prevent catheter-related bloodstream infections, and fewer than one in five providers think their institutions have sufficient infrastructure to train staff in prevention strategies.

And only one in four strongly believe their facility monitors compliance or holds staff accountable for adhering to best prevention practices.

Those are findings from a survey of more than 2,000 health providers—mostly hospital infection preventionists—released on Monday during the 37th annual meeting of the Association for Professionals in Infection Control and Epidemiology in New Orleans.

These infections are an increasing concern, with about 80,000 incidents happening each year in hospitals of which 30,000 result in death and with average costs of $30,000 per infected patient costing the U.S. healthcare system more than $2 billion annually.

"The attention or the urgency given to these infections does not seem to match the magnitude of the harm, (in either) resources or accountability," says Peter Pronovost, MD, APIC clinical advisor and professor at Johns Hopkins University School of Medicine.

Pronovost says the problem was miniscule compared to that which caused by faulty brake systems in Toyota cars: "Many of you probably saw the CEO of Toyota publicly apologize (because) four people died a year for five years needlessly, for a total of 20. Those deaths were tragic and he should apologize."

"But we know that in the U.S. alone, 30,000 to 31,000 people die a year from central line-associated bloodstream infections every year, and we have the technology that virtually eliminates that. And to have 75% of these (respondents) say they don't have accountability is alarming. What it speaks to me is an accountability failure in healthcare," says Pronovost.

The survey was sent to 20,415 healthcare professionals with APIC, the Association for Vascular Access and the Infusion Nurses Society, and the response was only 10%.

However, most of those who returned responses indicated they do not have effective programs in place to disseminate information on prevention. Fewer than 20% said their facility has effective infrastructure in place for training staff.

Making sure the hospitals accurately measure infection rates is another issue.

Pronovost, widely credited for his simple five-point checklist to prevent central line-associated bloodstream infections (Remove unnecessary lines, wash hands prior to procedure, use maximal barrier precautions, clean skin with chlorhexidine and avoid femoral lines) had some suggestions for getting hospital CEOs on board with aggressive prevention campaigns.

He says that when he visits hospitals to talk about the issue "I get staff saying, ‘We're using the checklist, Peter.' And I say great, but what are your infection rates? And they are commonly very high or they don't know."

Another big issue is the culture of denial of physicians and other clinicians who insert lines and refuse to use the checklist, a behavior Pronovost called, "essentially, arrogance among medical staff."

Nurses tell him they don't have the culture, and that if they question a physician who is not using the checklist, they tell him, "I'll get my head bit off."

Getting top down support is one way to eliminate that problem.

"One way to do this is what we call the opportunity estimator. If you put in your infection rates and your catheter days per year, this gives you an estimate of how many people died and how many dollars you spent needlessly on infections...If you want to get your CEO engaged, simply walk up to them and say, ‘here's how many people died and how many dollars you spent needlessly on infections. And here's what we're going to do about it."

“When that happens, we find that CEOs haven't been made aware of it," Pronovost adds. "Once you commit fundamentally that these infections are preventable, then all the rest follows."

Eventually, public pressure will take over. APIC, Pronovost, and others are working with states to strengthen infection rate reporting requirements, which now exist in 30 states and an increasing number of hospitals will be expected to post their rates online for public comparison.

Also in the works are a number of measures that will bring hospital executive leadership on board. These include tougher federal policies that deny reimbursement to hospitals with higher rates of infection and computerized surveillance systems to quickly identify hospital-acquired infections.

"All these together are going to be what's needed to drive rates down," Pronovost says.

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