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NIH and CDC update guidelines to protect patients from bloodstream infections

Mon, 04/04/2011 - 11:21am
National Institutes of Health

New guidelines outline steps to eliminate catheter-related bloodstream infections (CRBSI), one of the most deadly and costly threats to patient safety. Released by the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (http://www.cdc.gov/hicpac/), the guidelines were developed by a working group led by clinical scientists from the National Institutes of Health Clinical Center Critical Care Medicine Department (CCMD) along with 14 other professional organizations.

"The publication of these guidelines is a great contribution to the continued improvement of quality patient care and is illustrative of the power of collaboration across government agencies and with academic institutions," said NIH Director Dr. Francis S. Collins.

Major areas of emphasis in the guidelines include educating and training health care personnel, using maximal sterile barrier precautions during catheter insertion, cleaning skin with chlorhexidine (an antibacterial scrub), and avoiding routine replacement of certain catheters.

"Preventing these infections is an excellent example of how hospitals and other health care facilities can improve patient care and save lives, all while reducing excess medical costs," said Thomas R. Frieden, M.D., M.P.H., CDC director (http://www.cdc.gov/about/leadership/leaders/Frieden.htm).

Replacing a 2002 edition, the new guidelines are titled "Guidelines for the Prevention of Intravascular Catheter-Related Infections" (http://www.cdc.gov/hicpac/)and were published April 1, 2011, in Clinical Infectious Diseases (http://cid.oxfordjournals.org/content/early/2011/03/30/cid.cir257.full) and are available on CDC's HICPAC (http://www.cdc.gov/hicpac/) website. They will also be included in a special supplement to the American Journal of Infection Control (http://www.ajicjournal.org/). HICPAC advises CDC on infection prevention in healthcare facilities.

"Catheter-related bloodstream infections — like many infections in health care — are now seen as largely preventable," said lead author Naomi O'Grady, M.D., medical director of procedures, vascular access, and conscious sedation services at the NIH Clinical Center CCMD. "Implementation of these critical infection control guidelines is an important benchmark of health care quality and patient safety."

Efforts to track, report, and prevent bloodstream infections have improved in recent years. As part of its Action Plan to Prevent HAIs (http://www.hhs.gov/ash/initiatives/hai/index.html), the U.S. Department of Health and Human Services (http://www.hhs.gov/) has a national goal of reducing one type of CRBSI, central line-associated bloodstream infections (CLABSI), by 50 percent by 2013.

Starting in 2011, hospitals throughout the country must track and report CLABSIs in intensive care units in order to get an annual 2 percent Medicare payment increase. Hospitals will report their infection rates to CDC's National Healthcare Safety Network, and the data will be shared with the Centers for Medicare and Medicaid Services (http://www.cms.gov/). These data will be made available to the public later this year on the Hospital Compare (http://www.hospitalcompare.hhs.gov/) website.

In addition to local efforts, a prevention effort called On the CUSP: Stop BSI (http://www.onthecuspstophai.org/) has been expanded nationally through funding from the Agency for Healthcare Research and Quality (AHRQ) (http://www.ahrq.gov/qual/cusp.htm). Also, CDC has provided funding in recent years to state health departments (http://www.cdc.gov/HAI/stateplans/HAIstatePlans-map.html) to allow for better tracking and prevention efforts at the state level.

The combination of national and local focus on preventing CRBSIs, and specifically CLABSIs, has proven to be effective in improving patient safety. A recent CDC report showed a 58 percent decrease in CLABSIs among hospital ICU patients in 2009, compared to 2001. In 2009 alone, reducing these infections saved about 3,000 to 6,000 lives and about $414 million in extra medical costs, compared with 2001. However, infections still occur in healthcare settings, and diligent prevention efforts must continue.

"Education and reinforcement of care and maintenance protocols among staff is key. We all have a role to play in protecting patients from these infections," O'Grady said.

The NIH Clinical Center (CC) is the clinical research hospital for the National Institutes of Health. Through clinical research, physician-investigators translate laboratory discoveries into better treatments, therapies and interventions to improve the nation's health. For more information, visit http://clinicalcenter.nih.gov.

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