For one year and counting, Long Island Jewish (LIJ) Medical Center has achieved a zero central-line infection rate in its surgical intensive care unit (SICU), a significant accomplishment for hospitals.
"This milestone for LIJ could only be made possible with enormous teamwork and interdisciplinary collaboration among our medical staff," says Chantal Weinhold, executive director of LIJ. "Thanks to the efforts of our highly committed staff, the surgical ICU and hospital are made safer every day for our patients."
Central-line infections are one of the most serious that occur each year in hospitals. This bloodstream infection is introduced through large intravenous (IV) catheters that deliver nutrition, medications and fluids to the body of critical care patients.
"Using evidence-based strategies, a daily process and collaboration among the critical care team surgical residents, physician assistants, nurses and an intensivist we were able to eliminate central-line infections in the SICU and decrease them throughout the hospital," says Rafael Barrera, MD, director of the hospitals SICU.
From July 25, 2009 until July 25, 2010, LIJs SICU staff admitted nearly 750 patients for a total of more than 3,300 central line days -- the total number of days that SICU patients had the IV catheter inserted.
Before LIJ started the infection prevention initiative, the central-line infection rate was 1.26 per 1,000 central line days. According to the Institute for Healthcare Improvement, there are approximately 5.3 central line-associated blood stream infections per 1,000 central line days in ICUs nationwide. While LIJs central-line infection rate was lower than the national average, catheter-related bloodstream infections are a serious concern for patients and hospitals across the country. In July, the Association for Professionals in Infection Control and Epidemiology (APIC) released a report among more than 2,000 health providers mostly hospital infection preventionists estimating that about 80,000 central-line infections occur each year in hospitals, which are responsible for approximately 30,000 deaths. In addition, the average cost of treating an infected patient was $30,000, costing the U.S. healthcare system more than $2 billion annually.
To prevent central line infections, the SICU critical care team used a checklist for the safest and most sterile way to insert IV catheter lines. "To ensure that all central lines are placed correctly, physicians and surgical physician assistants use ultrasound guidance and adhere to strict protocols for insertion," says Barrera. The LIJ team implemented other key steps to prevent central line infections, including proper line maintenance and continuous surveillance.
"Nurses monitor lines daily and each time we need to use the central line, we thoroughly clean the catheter port for at least 20 seconds, (known as "scrub the hub"), which further reduces a chance of infection," Barrera adds. "Staff members also inspect central lines twice a day as soon as a line is not needed we take it out. The longer a line is left in the higher risk of infection."
Adding to the success at LIJ, Barrera says that a designated nursing IV team, supported by the surgical continuum of care of physician assistants, follows patients with central lines who are transferred to other areas of the hospital to maintain lines and further prevent infection. The team monitors the central lines on a daily basis and removes the central line when it is deemed to be no longer required. The infection rates in the non-critical care areas have also decreased dramatically as a result of the initiative.
Barrera says the entire team; SICU staff, the IV team and the physician assistants providing surgical continuum of care at LIJ, is accountable and takes ownership of the central line process. "Everyone knows their roles; its a lot of coordination and teamwork but now that the process is in place it is seamless," he says.