Improving patient care by reducing HAIs

With the U.S. Centers for Disease Control (CDC) estimating that two million people in the U.S. each year contract an infection unrelated to their primary condition during a hospital stay, one of the country’s major healthcare concerns is the prevalence and prevention of hospital-acquired infections (HAIs).

An even more shocking CDC statistic is that approximately 90,000 people die each year in the U.S. from HAIs – that’s nearly 250 patients every day. In light of these numbers, healthcare providers across the country have been vigorously researching and implementing processes and procedures aimed at lowering the incidence rates of HAIs.

This is a goal that has proved difficult to achieve by many measures. HAIs remain prominent even as hospitals continually improve infection control measures. Across the country, intensive care unit (ICU) staffs work diligently to employ CDC-recommended guidelines and improve hygiene protocols, such as the practice of proper hand hygiene.

One of the most common and deadly HAIs is a catheterdefine-related bloodstream infection (CRBSI). CRBSIs develop when bacteria enter a patient’s bloodstream when using a central venous catheter (CVC), which is usually inserted in patients in need of frequent or continuous injections of medications or fluids. These infections can lead to acute respiratory-distress syndrome, kidney failure, shock and other potentially fatal ailments.

The CDC estimates at least 250,000 cases of CRBSIs are diagnosed annually, with an associated attributable mortality rate of 12 to 25 percent. Additional treatment costs for these infections average about $35,000 per infection. Clearly, preventing CRBSIs must be a major priority to protect patients’ lives and help reduce skyrocketing health care costs.

The Medical/Surgical ICUs at Missouri Baptist Medical Center (MBMC) in St. Louis have embraced several preventative measures to lower the incidence rates of CRBSIs. These include proper hand-washing practices and maximal sterile barrier precautions.

Additionally, MBMC incorporates the use of skin disinfectants to sanitize the insertion area and utilizes a central venous catheter impregnated with antibiotics. To ensure the most effective care, an insertion checklist is completed for every CVC introduced. MBMC exchanges the catheters after they have been in place for longer periods of time, as data suggests that infections are more likely to occur after one week of catheter use.

For nearly 10 years, Missouri Baptist Medical Center has been one of the select hospitals in St. Louis using antibioticdefine impregnated CVCs, which have helped to reduce the occurrence of CRBSIs. The antimicrobial agents impregnated in the catheter, minocycline and rifampin, work synergistically to uniquely protect patients from bacterial organisms that can enter the bloodstream and cause an infection.

Many studies, including an article in the New England Journal of Medicine, have demonstrated the minocycline-rifampin catheters are effective in significantly reducing CRBSIs. As evidence, MBMC has gone 607 days, and counting, without a single CRBSI in its ICUs.

The goal for every hospital is to provide the best patient safety and quality of care, and having a multidimensional strategy of best practices and best technology can undoubtedly make a significant difference in solving this complex issue of reducing the rate of HAIs and improving patient care.

Dr. Michael Cox is Director of Critical Care Medicine and Associate Chief of Medicine at the Missouri Baptist Medical Center in St. Louis, Missouri.