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Simple Measures Reduce Bloodstream Infections

Study suggests hospitals pay attention to low-tech steps such as hand washing

WEDNESDAY, Dec. 27, 2006 (HealthDay News) -- Every year in U.S. hospitals, nearly 80,000 bloodstream infections result from central venous catheters -- devices inserted through a blood vessel that ends near or in the heart to administer medications, nutrients or other treatments.

And about 28,000 people die annually from the infections.

Now, researchers from Johns Hopkins University and other facilities have discovered that simple measures, such as hand washing, can make a dramatic difference in reducing these infections, leaving nearly all of them preventable.

"It's a huge problem," said Dr. Peter Pronovost, the study's lead author and a professor of medicine and medical director of Hopkins' Center for Innovation in Quality Patient Care. "In every intensive-care unit around the country, patients every week are commonly harmed by these infections."

Pronovost and his colleagues used a program that had been piloted at Johns Hopkins, trying it in 108 intensive-care units in Michigan, with 103 of them reporting data. The analysis included 1,981 "ICU-months" of data and more than 375,000 "catheter-days." Data was collected for up to 18 months after the safety measures were put in place.

"We focused on improved team work, with doctors and nurses working together, checking each other to make sure the catheter is placed properly and that each was using equipment known to prevent infection, like wearing a cap," Pronovost said.

In addition, the health professionals were asked to focus on five procedures known to reduce the infection risk. They are hand washing; using full-barrier precautions during the insertion of the catheters; cleaning the skin with chlorhexidine; avoiding the femoral site (thigh bone area) if possible; and removing unneeded catheters. The femoral artery in the groin is an area difficult to keep sterile.

"Many doctors accepted this as a cost of doing business," Pronovost said, referring to the bloodstream infections. When he started the study, he said, many of his colleagues were skeptical that the situation could be improved much.

"What we showed was that nearly all of these [infections] are preventable," Pronovost said. The median rate of catheter-related bloodstream infections per 1,000 catheter days declined from 2.7 at the start of the trial to zero. And the mean -- or average -- rate dropped from 7.7 at the start to 1.4 at the 16- to 18-month follow-up.

The study is published in the Dec. 28 issue of the New England Journal of Medicine.

Dr. Richard P. Wenzel is chairman of the department of internal medicine at Virginia Commonwealth University, who co-authored a journal editorial accompanying the study. "The emphasis on protocols and hygiene made a difference. Team work was critical," he said of the program, which asked doctors and nurses to check each other on the hygiene protocols.

Dr. Jane Siegel, professor of pediatrics and an infectious-disease specialist at the University of Texas Southwestern Medical Center at Dallas, said: "There have been studies of this type in individual institutions. This study was done in many hospitals, and it worked, proving it can work on a large scale."

The main message is intended for health-care professionals, but consumers can take practical and usable advice from the study, the authors and other experts concurred.

Said Siegel: "The patient or the patient advocate should be looking to see if the health-care professional is using good hygiene, changing the dressing, attentive to things that can be done to reduce the risk of infections."

Wenzel is even more assertive. He tells his own patients who have venous catheters to say to nurses, doctors and medical students: "Dr. Wenzel said you need to wash your hands before you touch me or any of my catheters."

More information

To learn more about hospital-acquired infections, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Peter Pronovost, M.D., Ph.D., professor of medicine, and medical director, Center for Innovation in Quality Patient Care, Johns Hopkins University School of Medicine, Baltimore; Jane Siegel, M.D., professor of pediatrics, University of Texas Southwestern Medical Center at Dallas; Richard P. Wenzel, M.D., professor and chairman, department of internal medicine, Virginia Commonwealth University, Richmond; Dec. 28, 2006, New England Journal of Medicine
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