With Medicare threatening to reduce payments for hospital-acquired conditions, a consortium of academic medical centers is ramping up the effort to track and stop catheter-related bloodstream infections, a growing acute care concern.
University HealthSystem Consortium, an alliance of 107 academic medical centers with 234 affiliated hospitals in the U.S., wants to reduce the number of catheter-related bloodstream infections, or CRBSIs, by streamlining systems of care and hospital practice cultures that cause them.
According to the Centers for Disease Control and Prevention, CRBSIs cause significantly increased illness and lengths of stay for 82,000 patients a year, and cause up to 28,000, just in intensive care units. And the average additional hospital cost to treat each infection is $45,000.
It used to be that many hospitals thought CRBSIs were unavoidable. Often they occur in the sickest of their patients, people with multiple co-morbidities and immune system problems who are especially vulnerable.
Now, however, hospitals are starting to realize that even these patients don't have to die because of something the hospital could have prevented.
For example, the program calls for hospital intensive care unit personnel to use special kits that arrange the parts needed to insert a catheter in the order of their use, to support the best practice, says Julie Cerese, UHC vice president of performance improvement.
Each unit of each hospital may be prompted to set benchmarks to reduce their own rates of infection.
Cerese says the program targets not just hospital workers at the bedside who insert the catheters, but mid-level managers and hospital CEOs as well. That's because designing effective prevention strategies requires a top-down effort to evaluate various products such as catheters tipped with antibiotics and other products to see which might be most effective.
One important effort in the process is to empower hospital providers to say "Wait, Stop this procedure" when they see a colleague engaging in an insertion practice that violates prevention protocols, Cerese says.
Members of the coalition are being encouraged to share stories about strategies that seem to work, and to submit their infection numbers to compare with other hospitals with similar patient populations.
Another important guideline, Cerese says, is to have hospital policies implement a daily practice of re-evaluating whether the patient still needs to have a catheter. "People should be asking the question every day. Does the patient continue to need this catheter," Cerese says.
Since the focus of UHC's effort is academic centers, one emphasis is in educating the many types of providers who come in contact with patients who might otherwise be missed in the educational process about hospital protocols, such as medical students, nursing students, residents, fellows, Cerese says.
The stepped up UHC effort comes on the heels of a February report in the British Medical Journal that found 90 intensive care units could reduce the mean number of CRBSIs from 7.7 per 1,000 catheter days to 1.3 by implementing five evidence based practice recommendations for 16 to 18 months.
The practices included four related to the catheter insertion process itself. They were hand washing, using full barrier precautions, cleaning skin with chlorhexidine and avoiding the femoral site when possible.
The fifth recommendation was to remove unnecessary catheters.