UNC Hospitals Reduce Central Line-Associated Bloodstream Infections by 85 Percent

The rate of central line-associated bloodstream infections at the University of North Carolina Hospitals has been reduced by 85 percent over the last 10 years, a new study by UNC researchers finds.

This in turn resulted in the prevention of an estimated 887 infections and 244 deaths and saved the hospitals more than $20 million in treatment costs, said William A. Rutala, MPH, PhD, director of hospital epidemiology at UNC Hospitals and one of four authors of the study, which was published in the August 2010 issue of the journal Infection Control and Hospital Epidemiology.

"We believe that these multiple interventions and new technological advances will continue to aid in the dramatic reduction in the rate of central line-associated bloodstream infections among intensive care unit patients and demonstrates UNC Health Cares commitment to improving patient safety," Rutala says.

In addition to Rutala, authors of the study were David J. Weber, MD, MPH, Vickie M. Brown, RN, MPH, and Emily E. Sickbert-Bennett, PhD. All work in the department that oversees infection prevention practices at UNC Hospitals.

A "central line" is a tube that enters a large blood vessel close to the heart and is used to deliver medications or fluids or to monitor vital signs. Each year central line-associated bloodstream infections cause more than 30,000 deaths in U.S. hospitals and cost the U.S. healthcare system an estimated $2 billion. Its such a serious problem that next year the Centers for Medicare and Medicaid Services (CMS) will begin requiring hospitals that accept Medicare and Medicaid to report central line-associated bloodstream infections to the Centers for Disease Control and Prevention (CDC).

In 1999, the central-line infection rate at UNC Hospitals was 8.9 infections per 1,000 catheter days. By 2009 that had been reduced to 1.3 infections per 1,000 catheter days, the study found.

Starting in 2000, UNC Hospitals began introducing new infection prevention practices aimed at reducing the number of central-line infections. That year medical staff received enhanced education about proper catheter insertion and maintenance. In addition, staff began using a highly effective antiseptic containing chlorhexidine gluconate and alcohol to prepare the skin for catheter insertion.

"Each year we introduced a new intervention and the infection rate continued to decrease ," Rutala says. Additional training for nurses was added in 2001 and in 2003 medical staff began using customized kits that included a full body drape for the patient and safety devices to prevent needlestick injuries.

In 2006, the medical intensive care unit began using a "bundle" of measures recommended by the Institute for Healthcare Improvement. The bundle included a paper checklist that nurses used while physicians were inserting a central line.

"The nurses used the checklist to make sure that everyones hands were washed, that the full-body drape was used, that the appropriate site was chosen, and that the skin prep was done correctly," says Sickbert-Bennett. "The medical ICU then shared their success story with the other ICUs, and now all of the ICUs are using this checklist approach for proper insertion of the central lines," she said.

The study concludes that no single intervention, by itself, was responsible for the overall reduction in central line infections. Instead, the "sequential introduction of improved procedures and new technologies resulted in a sustained and progressive decrease" in infection rates across all of the intensive care units at UNC Hospitals.