Building on the success of recent efforts to reduce health care–associated infections, officials at the Centers for Disease Control and Prevention have released updated guidelines for the prevention of catheter-related bloodstream infections.
The guidelines were published on April 1 in the journal Clinical Infectious Diseases, and are available online through the CDC. Last updated in 2002, the guidelines are aimed at health care providers who insert intravascular catheters and those who are responsible for surveillance and control of infections in the hospital, in outpatient settings, and in home health care settings.
They focus on five major areas:
• Educating and training health care providers.
• Using maximal sterile barrier precautions during central venous catheter insertion.
• Avoiding routine replacement of central venous catheters.
• Cleaning skin with chlorhexidine; avoiding routine replacement of central venous catheters.
• Using antiseptic/antibiotic-impregnated short-term central venous catheters and chlorhexidine-impregnated sponge dressings if infection rates are not decreasing through other strategies.
The guidelines were developed by a working group led by scientists at the National Institutes of Health, along with input from several other professional organizations including the Society of Critical Care Medicine, the American College of Chest Physicians, the American Thoracic Society, the American Academy of Pediatrics, and the Association for Professionals in Infection Control and Epidemiology (APIC).
The guidelines are being released at a critical time, Russell N. Olmsted, APIC president, said in a statement, because starting this year, hospitals must track and report on central line–associated bloodstream infections in their intensive care units or risk losing 2% of their Medicare payments. These data will be published later this year on Medicare’s Hospital Compare Web site. The Department of Health and Human Services has also set a national goal of reducing central line–associated bloodstream infections by 50% by 2013.
"Catheter-related bloodstream infections – like many infections in health care – are now seen as largely preventable," Dr. Naomi O’Grady, of the NIH Clinical Center Critical Care Medicine Department, and the lead author of the guidelines, said in a statement. "Implementation of these critical infection control guidelines is an important benchmark of health care quality and patient safety."
The country is already seeing success in reducing bloodstream infections. Recent data from the CDC showed that the number of central line–associated bloodstream infections occurring in ICUs across the country dropped by about 25,000 or 58% from 2001 to 2009 (MMWR 2011;60:1-6). The prevention of central line–associated bloodstream infections in the ICU resulted in total savings of about $1.8 billion and as many as 27,000 lives saved between 2001 and 2009, according to the CDC.
And a new report from the Agency for Healthcare Research and Quality shows that hospitals participating in the national quality project "On the CUSP: Stop BSI" were able to significantly reduce their central line–associated bloodstream infections. The initial results from adult ICUs in 22 states showed a 35% reduction in central line–associated bloodstream infections. The rates dropped from an average of 1.8 infections per 1,000 central line–days to an average of 1.17 infections per 1,000 central line–days.