DALLAS — Fewer than half of U.S. hospitals—with the notable exception of those in the VA system—utilize all three widely recommended practices for preventing central venous catheter-associated bloodstream infections, according to a national survey.
The survey showed that 62% of Veterans Affairs hospitals take a comprehensive approach to prevention of central venous catheter-associated bloodstream infections, utilizing all three preventive practices. That's true of only 44% of the nation's non-VA hospitals, Dr. Sanjay Saint reported at the annual meeting of the Society of Hospital Medicine.
He and his colleagues conducted a survey of catheter-associated infection prevention practices at all 119 VA medical centers and a random national sample of more than 400 nonfederal hospitals with more than 50 beds and an ICU.
Guidelines strongly recommend three proven preventive strategies. Yet until now there have been no national data characterizing the extent to which hospitals are using them, which was the impetus for the survey, explained Dr. Saint of the University of Michigan, Ann Arbor.
The three key evidence-based preventive practices are use of maximal sterile barrier precautions, routinely employed in 84% of VA and 71% of nonfederal hospitals; chlorhexidine gluconate as an injection-site antiseptic, utilized in 91% of VA and 69% of non-VA hospitals; and avoidance of routine central line changes.
The survey also included semistructured telephone interviews with hospital infection control officers and on-site visits to identify barriers to implementation of the preventive practices. Among the most commonly cited barriers were “organizational constipators,” Dr. Saint's term for mid- to high-level managers resistant to change.
Factors identified as conducive to use of the three preventive strategies included a hospital culture that places a premium on patient safety, encouragement of multidisciplinary infection prevention collaboratives, and having a champion of evidence-based change, which in most cases was an intensivist. That's a role hospitalists could fill as well, Dr. Saint observed.