Tampa General Hospital's Success in Eliminating Bloodstream Infections in ECMO Patients

Tampa General Hospital (TGH), a leading tertiary care academic medical center, has successfully eradicated bloodstream infections (BSIs) in patients undergoing extracorporeal membrane oxygenation (ECMO) within their 18-bed cardiothoracic intensive care unit (CTICU).

This achievement was showcased in a presentation titled “Bundled Approach to Reduce Bloodstream Infections in Patients Requiring Use of Extracorporeal Membrane Oxygenation” at the 2024 Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference & Exposition in San Antonio, Texas, held from June 3 to 5. There, TGH representatives reported a reduction in ECMO-related BSI rates from 36% in October 2021 to 0% in April 2022. This zero-infection rate was sustained for 7 months, with the hospital maintaining a 4-month streak of no infections.

To find out how that reduction was accomplished, Infection Control Today^® (ICT^®) spoke with the authors of the study, all of whom work for Tampa General Hospital: Mini Radhakrishnan, BSN, RN, CIC, the infection preventionist, and Kimberly E. Atrubin, MPH, CIC, CPHQ, FAPIC, the infection prevention director. The other authors were Carmen M. Murphy, MSN, RN, CIC, FAPIC, the infection prevention manager, and Lauren Wojciechowski, DNP, AGACNP-BC, nurse practitioner.

“When we did our literature review, we did find that there was no standardized protocol underlying care of ECMO patients,” Radhakrishnan told ICT. “There were protocols in place somewhat aligned to central line bloodstream infection, but they did not customize to the patient's need. In our facility during the [COVID-19] era, we noticed a high spike in bloodstream infections; it rose to about 36% in October [2021].”

The team did a literature review to focus on ECMO patients and the bloodstream infections they get. “We found so many environmental clinical risk factors underlining patients,” Radhakrishnan explained. “So, amalgamating all that and the patient's risk factors, we came up with a management approach to reduce ECMO. And that is my presentation today.”

The authors emphasized that they did not reach their goal of no infections without teamwork. “Really big kudos to [Radhakrishnan] for even identifying the fact that we had several bloodstream infections,” Atrubin said. “And to even go down this pathway because it's not a traditional element of surveillance. So, it's not something that we have to report nationally through the National Healthcare Safety Network (NHSN). So, this could easily be something that gets lost in routine infection prevention departments. So, for her even identifying that this was an issue in our unit, and then having to kind of work through that process [of] working with the team and collaborating with them, and coming up with a tool that would help us improve [the issue] was outstanding work.”