Study Seeks Strategies to Prevent Catheter-Related Infections

By Sharron Walls

A Medical College of Georgia study seeks to learn how to optimize communications to avoid potentially deadly catheter-related bloodstream infections.

Nearly half of patients in intensive care units need catheters to deliver medicine or replenish fluids. In the United States, catheter-related bloodstream infections cause as many as 28,000 deaths and $9 billion in healthcare costs each year.

Such infections are completely preventable if correct practices are followed, according to the Centers for Disease Control and Prevention (CDC). Those practices include hand hygiene, full barrier precautions, patient skin antisepsis, appropriate catheter site selection and daily review of whether the line is still necessary.

"Evidence-based practices have been developed and promoted, but while some hospitals have succeeded in implementing these standards, many have not," says Dr. Pavani Rangachari, assistant professor of health informatics in the School of Allied Health Sciences and principal investigator on the study. "We do not have a systematic understanding of how hospital organizations learn to prevent infections. By understanding these dynamics and making them available to practitioners and policy makers, this study may enable a faster spread of hospital infection prevention efforts."

The multidisciplinary two-year, $100,000 study is sponsored by the Department of Health and Human Services Agency for Healthcare Research and Quality.

Rangachari and her colleagues will collect weekly data from MCGs medical and pediatric intensive care units beginning in January, analyzing communication logs to determine how catheter-related bloodstream infections prevention practices are communicated to physicians and nurses and which are most effective.

For instance, some hospital personnel communicate tacitly such as medical faculty telling residents the importance of using full barrier precautions (airborne and contact precautions, plus eye protection and standard precautions). Others communicate explicitly, such as hospital administrators disseminating monthly infection rates during staff meetings.

"We want to understand which structures of communication and types of knowledge exchanges are associated with the successful implementation of evidence-based practices," Rangachari says. "In short, how does safety learning occur at the unit level?"

The problem is that some practitioners think they are following proper procedures when they are not. The better they understand how to communicate, Rangachari theorizes, the safer they can keep their patients.

"Theres a big incentive now for hospitals to follow these procedures," she adds. Beginning in 2011, hospitals will be required to publicly report hospital-acquired infections and will be penalized for them.

Rangachari hopes the research will lead to a larger, multi-site infection prevention trial. "This is clinical, public health and patient safety research all rolled into one, with a broad applicability making it relevant to policy makers, health care practitioners and the public."

Collaborating on the study with Rangachari are Drs. Chitra Mani, professor of pediatrics, Peter Rissing, chief of infectious diseases, David Snyder, chief quality officer at MCG Health and Peggy Wagner, professor of family medicine.