Government report reviews state efforts on bloodstream infections; evaluates impact of countrywide implementation of Pronovost program

A new report from the House Oversight and Government Reform Committee evaluates states’ efforts to reduce or eliminate central-line-associated bloodstream infections (CLABSIs). The report also compares state efforts to work done by Dr. Peter Pronovost of Johns Hopkins University to identify practices to reduce CLABSIs. In 2003, the Michigan Hospital Association adopted the Hopkins program statewide, thus supporting efforts to dramatically reduce bloodstream infections.

According to the Committee report , if all state hospital associations were to implement the MHA/Johns Hopkins program, as many as 15,680 additional lives and as much as $1.3 billion could be saved each year. Further, only eight state hospital associations gather comprehensive data on CLABSI rates. Another 12 state hospital associations report that they have begun collection of these data, and every state hospital association reported that it was engaged in some activities to reduce hospital-associated infections, such as efforts to reduce ventilator-associated pneumonias and surgical site skin infections.

CLABSIs are almost entirely preventable if hospitals follow certain procedures. The current CDC guidelines for preventing catheter-related infections include 111 practice recommendations, of which 39 are “strongly recommended.” Dr. Peter Pronovost, a researcher at Johns Hopkins University School of Medicine, has identified five simple and inexpensive practices that reduce catheter infections. These five steps are:

1. Handwashing;

2. Full draping of the patient;

3. Cleaning the skin with proven cleansers;

4. Avoiding catheters in the groin if possible; and

5. Removing catheters as soon as possible.

These steps are well-established practices that physicians and hospital infection control units should be encouraging. In his research, however, Dr. Pronovost found that doctors were skipping steps more than a third of the time. To promote greater compliance, he and his ensure that these five steps were followed every time. The program consisted of:

• Educating clinicians;

• Urging hospitals to create and use a “central line cart” so all supplies would be in one accessible location;

• Creating a checklist to ensure that all five steps were completed each time;

• Empowering hospital staffs to stop procedures if the checklist is not being followed;

• Ensuring that data are reported by hospitals according to the national CDC standards; and

• Providing monthly and quarterly feedback to hospitals on the rates of infections.

In 2003, the Michigan Hospital Association (MHA) adopted the Johns Hopkins University program statewide. Hospital participants in this statewide program committed to participating in conference calls and meetings where team members share what they learned with other teams. The project also provided the hospitals with data support and reports. Within 18 months, the rate of CLABSIs in Michigan intensive care units dropped by 66%.9 The typical hospital (the median performers) virtually eliminated these infections and outperformed more than 90% of hospitals nationwide.10 The MHA estimates that during this 18-month project, they saved more than 1,729 lives and over $246 million, before taking into account the costs of administering the program.

(SOURCES: Advisory Board Daily Briefing , http://advisory.com, September 24, 2008; House Oversight and Government Reform Committee , http://oversight.house.gov, accessed September 27, 2008)