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Hospitals Reduce Bloodstream Infections Through Better Central Line Care

Disinfection caps and ‘scrub the hub’ regimens reduce infections, cut costs

Whether through the use of alcohol-containing caps or basic cleaning of the injection port of the central line, infection preventionists at three U.S. hospitals have found successful ways to stop germs from entering central-line catheters and causing bloodstream infections in patients.

Three abstracts, to be presented June 7 at the 41st Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC), address the challenge of keeping bacteria from entering the bloodstream through a central line.

Patients in intensive care units may need to have their lines accessed 20 or more times per day, increasing the risk of infection and contamination. Many facilities follow a bundle of best practices to reduce risk factors during the insertion of a central line, but continuous and safe maintenance of the line is difficult.

“Sharing successful process-improvement strategies for catheter maintenance is essential to continuing efforts to prevent these serious bloodstream infections,” said APIC president Jennie Mayfield, BSN, MPH, CIC. “For patients with long lengths of stay, maintenance-related issues become very important. As these examples demonstrate, each health system needs to review its own data and work as a team with front-line caregivers to tailor interventions that will be successful at their institution.”

In November 2012, infection preventionists at Texas Health Presbyterian Hospital in Dallas received approval from hospital administration to use alcohol-impregnated port protectors on every patient, for every port, on every unit. In 10 months, the rate of central line-associated bloodstream infections (CLABSIs) decreased by 68%. Seventeen CLABSIs were prevented, for a total cost savings of $410,000. In addition, by eliminating the need to “scrub the hub,” the researchers calculated an annual time savings of 144 nurse hours.

At Loyola University Medical Center in Maywood, Illinois, the infection prevention team compared disinfection caps, an intensive scrub-the-hub intervention, and standard care. A total of 59 CLABSIs occurred during the 12-month standard-care period compared with 23 CLABSIs during the 12-month intervention period, during which alcohol-impregnated disinfection caps were used on all central-line access ports. It was estimated that, by preventing these additional 36 CLABSIs, the institution reduced CLABSI-related costs by more than $1 million over the intervention year.

Further, after a decision in August 2012 to halt use of the alcohol-impregnated caps previously used on central lines at the University of Pittsburgh Medical Center St. Margaret, the 250-bed community hospital saw an increase in the number of CLABSIs. This led the infection prevention team to institute a “back to basics” approach to the maintenance of central lines.

The team rolled out a variety of educational tools, including videos, talking points, printed pocket cards, and postcards, as well as an extensive online manual accessible on the facility’s intranet. These tools covered topics such as scrubbing the hub, proper labeling, dressing, and tubing change requirements and techniques. The toolkit was introduced in May 2013, and the facility saw zero CLABSIs through November 2013.

Source: APIC; June 5, 2014.

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