New guidelines cut bloodstream infections
The success of any hospital infection control program may finally depend on one single thing: buy-in.
"If you don't have buy-in from the leadership of a unit, then it's not going to work because it involves folks making a conscious effort to do the right thing," says Vanderbilt infection control practitioner Kathie Wilkerson, R.N.
And she should know. Wilkerson has been part of a team who established a program in Vanderbilt's Medical Intensive Care Unit (MICU) to combat bloodstream infections in patients by standardizing the insertion of central venous catheters (CVCs). Three years after the implementation of that program in 2002, the infection rate in those patients had declined by 75 percent.
And now, some four years after that effort first began, the program has been put in place in other ICUs throughout the hospital with great success.
In dollars and cents, the outcome of the program has quickly added up. Chief Hospital Epidemiologist Thomas R. Talbot, M.D., M.P.H., has estimated the cost savings of using the program in all the ICUs at $1.3 million to $3.9 million, based on the prevention of 114 CVC bloodstream infections. And some of Vanderbilt's general care units have expressed an interest in instituting the program.
Bloodstream infections from CVC catheters are one of the major infection problems in hospitals around the country. These larger catheters, which typically are placed in one of the body's main veins, put patients at more infection risk than smaller, peripheral intravenous lines. The threat of infection is a particular concern in ICUs, which tend to have sicker, more vulnerable patients.
Vanderbilt's CVC insertion program aims to arm caregivers, who insert and take care of these catheters, with the information they need to do that as safely as possible every time. The Department of Infection Control & Prevention Web site tutorial addresses hygiene issues, insertion locations, patient positioning, skin cleansing and sterile barrier precautions. The guidelines also discuss caring for, removing and replacing CVC catheters, and include current information on issues related to the procedure.
Getting all involved parties on board to implement a new program sometimes is a challenge. And for those who work in ICUs, it's just one more thing on their plate," Wilkerson observes.
Continuing education is a hallmark of any successful infection control effort, and the CVC insertion project has built that in with online training for doctors and nurses who are newly assigned to the ICUs. A checklist that nurses use to track the step-by-step CVC insertion process also serves as a record of what was done, alleviating additional recordkeeping while also providing real-time performance feedback.
"It's not a magic bullet," Wilkerson says of the checklist. "It just makes sure people are following the guidelines."
The next step, Wilkerson says, is to develop a similar program for maintaining CVCs, which some patients can have for years. That may be an even bigger challenge.
Wilkerson and several of her colleagues – including Richard Wall, M.D., M.P.H., who pioneered the catheter project – were recognized with a national award in 2005 by their infection-control colleagues. Wilkerson, with 30 years in health care, was also recognized by the Centers for Disease Control and Prevention for her efforts to reduce
hospital-acquired infections. "There's never a dull moment in infection control," Wilkerson says. "It's always so interesting."
- Elizabeth Older