elcam medical safety

Safety is in the details

Infections in the ICU, Part 3

elcam medical safety

In Part One of this series, we shared a Wall Street Journal article that profiled a Chicago hospital study conducted to better understand how certain bacteria infiltrate US healthcare providers. As we mentioned, this important initiative is mapping “where hospital germs linger and what causes them to take root.”

We also took a look at a USA Today article revealing how a deadly pattern of hospital illnesses linked to a bacteria called carbapenem-resistant Enterobacteriaceae (CRE) has resulted in several deaths at, and become a major concern for, hospitals across the country.

In Part Two of this series, we explored central-line associated bloodstream infections (CLABSIs). As we briefly mentioned last time, according to InfectionControlDaily.com, healthcare institutions spend an estimated $9.8 billion every year treating the assortment of healthcare-associated infections (HAIs) that currently exist. CLABSIs are included in the group that falls into the top five most expensive HAIs to deal with.

Now in this final installment, we’d like to highlight another device-assisted infection: catheter-related bloodstream infections (CRBSIs).

According to online site VatorNews, there are 500,000 new CRBSI cases reported every year in the United States, “with costs exceeding $3 billion.” The Centers for Disease Control have, the piece relates, identified CRBSIs as “one of the seven major healthcare challenges” we currently face.

Some other interesting statistics:

  • SafeCareCampaign.org estimates that as many as 4,000 US patients die every year due to bloodstream infections. 
  • According to a European CDC report, The ICU mortality in patients with ICU-acquired bloodstream infections was 33.2%, higher than for patients without BSI. Length of stay in the ICU for patients with BSI was approximately 3.5 times higher than for patients without BSI.
  • Medscape.com places the number of central venous catheters (CVCs) used in the US each year at five million.
  • They also cite the “attributable cost of care” for the ICU at between $34,508 to $56,000 per episode.
  • The CDC cites CRBSIs as the most common cause of healthcare-associated bloodstream infections, with somewhere between 12% and 25% of infected patients dying every year, and many having to prolong their hospital stays at a significant cost.

It’s important to remember that in the US, Medicare will not cover the treatment of these types of hospital-acquired conditions (HACs) and, under the Affordable Care Act (ACA), hospitals with high rates of HACs will face penalties. In Europe, according to the World Health Organization and its recent study on the “Prevention of Hospital Infections by Intervention and Training”, there are great variations in the implementation of evidence-based  infection control (IC) recommendations.  While most European countries are required by law to issue infection prevention and Control programs only seven countries provide funding for them and attributable costs for HAIs are not reimbursed.

So, what preventative measures are recommended to combat these costly infections? In addition to adherence to cautious, and perhaps obvious, sterilization practices, the Institute for Healthcare Improvement (IHI) has put forth its central line bundle approach, where multiple preventative practices and procedures combine to stack the deck in favor of prevention, as one avenue.

As cited online by the Advance Healthcare Network for Nurses (nursing.advanceweb.com), IHI describes its bundles as “a group of evidence-based interventions that, when implemented together, result in better outcomes than when implemented individually.” In essence, the article relates, “they provide multiple lines of defense.” Other groups such as the CDC and the Society for Healthcare Epidemiology of America have offered their own central line bundles, yet consensus on how many lines of defense are effective or necessary has not been reached. The site does outline some practices associated with these approaches and, if you haven’t seen them already, it might be an interesting read.

As always, we’ll do our best to bring you any updates or developing news about “Infections in the ICU.” We hope you’ve enjoyed this series, and that you’ll come back for our next installment in “Safety in the ICU.”

See you next time.

Ilana Engel-Regev, MD

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