For years, catheter-related bloodstream infections seemed to be a sometimes unavoidable complication of caring for the sickest patients in intensive care units. The infections kill 17,000 patients annually, and the average cost of caring for an infected patient is $45,000, studies show.
But then a stunning thing happened: A group of Michigan hospitals implemented a relatively simple set of interventions, including a checklist of infection-control practices, and their average infection rate dropped 66% after one year. The median central-line infection rate fell to zero per 1,000 catheter days, compared with a national average of 5.2. The achievement was due to hand washing, using full-barrier precautions when inserting central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site for insertion and removing unnecessary catheters.
Three years after the project began, 85 Michigan ICUs have improved their success. The average infection rate has dropped 86%, while the median rate remains at zero, according to a Feb. 4 study published in the British medical journal BMJ.
“Most of the time these things go a different way,” said Peter J. Pronovost, MD, PhD, lead author of the study and a consultant on the Michigan project. “The history is that quality improvement is like an accordion. You push on it, it goes in, and then you stop pushing on it and it comes back out.”
The whole shebang.