Non-VA Hospitals Underuse Guidelines for Preventing Catheter-Related Infections

Will the New Medicare Ruling Stimulate More Adherence?

By Laura Brasseur

Sarah L. Krein (right) and

coinvestigator Sanjay Saint, MD, MPH.

Mayo Clin Proc

Although many acute-care hospitals in the United States use 2 of the most strongly recommended practices for preventing catheter-related bloodstream infections, fewer than half of non?Veterans Affairs (VA) hospitals use the more effective multiple-strategy approach, new research suggests (. 2007;82:672-678).

Each year, more than 200,000 patients in US hospitals develop catheter-related bloodstream infections, resulting in increased morbidity, mortality, length of hospitalization, and healthcare costs. The scope of the problem, coupled with the fact that >50% of such infections may be preventable, have recently prompted Medicare to announce it would no longer provide reimbursement for such infections.

Currently, 2 sets of guidelines for the prevention of catheter-related infections are available; one was issued by the Agency for Healthcare Research and Quality in 2001 and the other by the Centers for Disease Control and Prevention in 2002.

In this new study, investigators set out to determine if these guidelines are being followed. Surveys were sent out to infection control coordinators at 516 US hospitals, including a national random sample of VA and nonfederal hospitals. They were asked about the use of the following recommended practices, alone or concurrently, for preventing central venous catheter?related bloodstream infections:

• Maximal sterile barrier precautions (full gown, sterile gloves, large sterile patient drape)
• Chlorhexidine gluconate for insertion-site antisepsis
• Central venous catheters coated with antimicrobial agents (eg, chlorhexidine/silver sulfadiazine) when infection rates are high or the catheter will remain in place for more than 5 days
• Avoidance of routine central catheter line changes when infection is not suspected.

Analysis showed that VA hospitals tended to follow the guidelines more closely than non-VA hospitals (Table).

Table. Catheter-related infection prevention strategies used in US hopitals

Used in hospitals, %

Strategy

VA

Non-VA

Maximal sterile barriers

84

71

Chlorhexidine gluconate site antisepsis

91

69

Antimicrobial catheter

32

38

Avoidance of routine central line changes

81

84

Composite approach*

62

44

*Concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes.

Source

Mayo Clin Proc.

: Krein SL, et al. Use of central venous catheter-related bloodstream infection prevention practices by US hospitals. 2007;82:672-678.

IMWR

Speculating on this disparity, lead investigator Sarah L. Krein, PhD, RN, tells , "As with any practice change or new technology, some facilities are just slower than others in deciding to make a change, and this may be especially true if there is nothing to help stimulate the change. In the VA, there is a strong communication network among the infection control practitioners and a centralized effortto decrease catheter-related bloodstream infections."

In addition, "Non-VA hospitals that were participating in some type of collaborative initiative that focusedon reducing catheter-related bloodstream infections appeared to be more likely to use a composite approach," she says.

Dr Krein, a researcher at the VA Ann Arbor Healthcare System and assistant professor at the University of Michigan Medical School, also notes the role of the primary care physicianin preventing infections. "One waythat individual physicians can improve infection prevention practices is to be a visible and proactive champion or co-champion of a particular practice."

She adds, "As part of this study,we are also collecting and analyzing qualitative data to better understand why some hospitals are using certain practices, while others are not, and have many examples of individual physicians or physicians working in collaboration with nurses (eg, peripherally inserted central catheter nurses or nurse managers) who have played a major role in making certain infection prevention practices a standard of care attheir hospital."