Special Feature: New Study Looks at Ways to Reduce Catheter-Related Bloodstream Infections in Hospital ICUs
Debra: Each year, patients in the United States spend about 18 million days in the intensive care unit. More than half of that time, ICU patients will have a catheter inserted into a main vein to receive medications or fluids. What those patients don’t expect is that the catheter could make them sicker, or even kill them. As many as 80,000 patients each year develop catheter-related bloodstream infections, and about 28,000 of them will die from the infection. Through an AHRQ grant, Dr. Peter Pronovost, professor in the Departments of Anesthesiology and Critical Care, Surgery, and Health Policy and Management at the The Johns Hopkins University School of Medicine, studied an intervention that can substantially reduce the number of bloodstream infections caused by central venous catheters. He’s with us today to discuss his findings. Welcome, Dr. Pronovost. First, we should also be clear that a central venous catheter is different from the regular IV line that hospital patients usually have in their wrists or hands, and from the catheters used to collect urine. Isn’t that so?
Dr. Pronovost: Correct, these are catheters that are generally in a large blood vessel that lay outside the heart and they’re used to either monitor patients better or to deliver medications more effectively. A central venous catheter is placed in a large vein in either the neck or the upper chest, near the collar bone, that sometimes also are placed in the groin area. Central venous catheters may be used to deliver chemotherapy, long-term IV antibiotics or nutrition, long-term pain medications, dialysis, or other treatments.
Debra: How dangerous are catheter-related bloodstream infections?
Dr. Pronovost: They can be very dangerous as they can cause patients to die if not treated soon enough. The good news is that this study showed that there is a simple and inexpensive way to prevent or reduce the occurrence of infections among ICU patients.
Debra: Tell us about the study.
Dr. Pronovost: Sure. My colleagues and I looked at the records of clinicians that used five specific procedures to see how well they might reduce the incidence of these catheter related infections. These procedures were ones that the Centers for Disease Control and Prevention have identified as being effective and being easy to implement. The five relatively simple practices are: hand washing; using full barrier precautions, including gloves and gowns and paper drapings during the insertion of central venous catheters; cleaning the skin with chlorhexidine, a type of soap; avoiding the femoral site (in this case what’s called the groin); and removing catheters as soon as they are no longer needed.
Debra: And what were the results?
Dr. Pronovost: Well, the results were just astounding. The rate of blood stream infections was reduced by up to two-thirds and, interestingly, that reduction was maintained throughout the entire eighteen month study period in every type of hospital that we looked at.
Debra: And the costs were relatively minor also, weren’t they?
Dr. Pronovost: There were really no new costs for hospitals. The intervention did not require the use of any expensive technology or additional ICU staffing. The cost and efforts are so relatively minor that the five components of the intervention could easily be used, and likely should be used widely and adopted. Broad use of this intervention could significantly reduce morbidity and mortality for patients who receive these central catheters, and also can reduce the cost of care associated with catheter related blood stream infections.
Debra: It just seems that these interventions are so simple that I think a lot of people would be surprised that this is not already being done on a universal scale.
Dr. Pronovost: You’re absolutely right, and I kind of view this as almost an Olympic gymnast or diver, where them doing the procedure looks like or doing a dive or a jump looks so simple that we all say boy, why can’t I do that? But you don’t realize the elegance is really in the training and the sophistication to get to that point. So these procedures are simple they’re inexpensive. How to reorganize a health care system and change culture so that they’re routinely delivered to patients is what, I think, was novel about this study.
Debra: Based on your findings, what’s the bottom line message here?
Dr. Pronovost: The bottom line message is that for years, clinicians viewed catheter related infections as inevitable. And what our study showed is that the vast majority of them are preventable with simple inexpensive measures, and every hospital ought to be implementing these.
Debra: Dr. Pronovost, thank you so much for your time. Dr. Pronovost is a Professor in the Departments of Anesthesiology and Critical Care, Surgery, and Health Policy and Management at the The Johns Hopkins University School of Medicine. His study on catheter-related bloodstream infections was published in the December 28, 2006, issue of "The New England Journal of Medicine."