CDC Report Reveals Drop in Infections in ICU Patients With Central Lines

A new "Vital Signs" report from the Centers for Disease Control and Prevention (CDC) released today contains new data showing that 58 percent fewer bloodstream infections occurred in hospital ICU patients with central lines in 2009 than in 2001. In 2009, about 18,000 bloodstream infections occurred in ICU patients with central lines. About 23,000 more happened to patients who got treatment in other areas of the hospital.

Other highlights of the report are:

-- Overall, the decrease in infections saved up to 27,000 lives and is associated with $1.8B in excess medical costs. In 2009 alone, reducing infections saved about 3,000-6,000 lives and about $414 million in extra medical costs compared with 2001.

-- Bloodstream infections from Staphylococcus aureus in ICU patients with central lines were reduced by 73 percent, more than from any other pathogen.

The CDC says that although progress has been made in hospitals, even more must be done to protect patients from infection. The CDC report points out that many bloodstream infections occur in people who receive outpatient hemodialysis treatment through central lines:

- About 350,000 people receive life-saving hemodialysis treatment at any given time. About 8 in 10 of these patients start treatment through a central line.

- Infections are one of the leading causes of hospitalization and death for patients on hemodialysis.

- About 37,000 bloodstream infections occurred in 2008 in hemodialysis patients with central lines.

- A hemodialysis patient is 100 times more likely to get a bloodstream infection from MRSA than other people. MRSA is a type of staph that is resistant to certain antibiotics.

The Association for Professionals in Infection Control and Epidemiology (APIC) has released a statement in reponse to the CDC report:

"APIC applauds and appreciates the significant reduction in central line-associated bloodstream infections (CLABSIs), described in the new Vital Signs Report released today by the Centers for Disease Control and Prevention (CDC). The 58 percent decline in CLABSIs occurring in intensive care units (ICU) in 2009 compared with 2001 reflects a focus by direct care providers, in collaboration with infection preventionists, on improving patient safety and preventing this serious type of healthcare-associated infection (HAI).

"Most significantly, this means an estimated 6,000 lives of patients have been saved by preventing these often life-threatening bloodstream infections. The critical underlying foundation for these successes has been use of key prevention strategies that are based on scientific evidence outlined by the CDCs Healthcare Infection Control Practices Advisory Committee in 2002 and a soon-to-be-released 2011 update of its Guidelines for the Prevention of Intravascular Catheter-Related Infections. Prevention of CLABSIs has also been accelerated in many U.S. hospitals by a commitment to targeting zero CLABSIs in all patient care areas where central-line (central-venous catheters) are needed for patient care.

"While progress in preventing CLABSIs has been made in the ICU, the report showed that much work remains to be done in non-critical care areas, including outpatient and ambulatory settings. In particular, the report highlighted hemodialysis centers where central lines are used to administer adjunct treatment.

"Continued progress in preventing HAIs requires adequate resources dedicated to infection prevention and control programs. Healthcare institutions can replicate the CLABSI improvement efforts seen in ICUs by applying similar and equally rigorous prevention strategies and resources in other areas. Staff in outpatient settings, including hemodialysis centers, need resources and infection prevention education, in order for the most up-to-date, evidence-based measures to be applied on a consistent and sustained basis.

"This Vital Signs report also highlights the need for partnership between patients and their providers aimed at prevention. In particular, far too many patients in the U.S. are refusing use of an arterio-venous (A-V) fistula for their dialysis; instead, many patients prefer the use of a central line. The risk of bloodstream infection is significantly higher with a central line as compared to an A-V fistula. Therefore, APIC encourages those who need dialysis to adopt fistula first."

2011 APIC president Russ Olmsted says, "This report is a milestone in our progress toward elimination of CLABSIs but also a realization that many challenges remain; especially for non-ICU and dialysis settings where central lines are in use."

APIC published a Guide to the Elimination of Infections in Hemodialysis, in 2010 which details the steps that each facility needs to take to prevent infections and protect patients. In 2009, APIC also published a Guide to the Elimination of Catheter-Related Bloodstream Infections. Both of these guides illustrate the application of evidence to improve care at the bedside. In addition, APIC recently launched the I believe in zero CLABSIs initiative, including an online toolkit designed to help infection preventionists and front-line caregivers access the most current resources to lead CLABSI prevention programs in their facilities.

Olmstead adds, "Research continues to show that an increasing number of HAIs are preventable by consistent adherence to evidence-based strategies. The new report from the CDC provides compelling evidence that prevention strategies can be successful. APIC believes that continued use and monitoring of these strategies will support ongoing reduction in CLABSI, both in and outside the ICU."

To access the CDC report, visit: http://www.cdc.gov/VitalSigns/HAI/index.html

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