When a loved one is taken to a hospital’s intensive care unit, the expectation is that the patient will receive meticulous care and, with luck, recover. But too often that’s not what happens.
Speaking with the media Tuesday about a new Center for Disease Control report, CDC Director Dr. Thomas R. Frieden discussed a major reason why this is the case: central-line associated bloodstream infections in intensive care units, hospital and dialysis centers.
When a patient in an intensive care unit receives a central line – a tube usually placed in a large vein of the neck or chest to deliver treatment – a bloodstream infection can occur if the tube is not inserted correctly or isn’t kept clean. Then the tube can become a pipeline for germs to enter the body and cause life-threatening bloodstream infections.
“Central line associated bloodstream infections remain far too common,” said Frieden, noting that about 10,000 patients a year die in the United States from these infections.
The good news, according to Frieden, is that nationally the number is dropping. Bloodstream infections in intensive care unit patients with central lines decreased by 58 percent in 2009 compared to 2001, representing up to 27,000 lives saved and $1.8 billion in cumulative healthcare costs avoided.
While this represents a major step in the right direction, Friedan said there are areas where progress in reducing bloodstream infections has been slower, particularly in hemodialysis centers. Noting that there were 37,000 infections among dialysis patients in 2008, he said, “That represents about one out of every 10 patients on hemodialysis is getting an infection every year. Infection is the leading cause of death in these patients.”
The urgency for improved safety in hemodialysis clinics is compounded by the fact that the number of patients on dialysis is expected to double in the next 10 years as the population ages and more people are diagnosed with diabetes.
Connecticut has taken an aggressive approach to fighting the real dangers of hospital-associated infections, especially in dialysis clinics. In 2006, the General Assembly passed a law creating a mandatory reporting system for healthcare associated infections. In late 2010, the state began planning a process to monitor and reduce hospital associated infections in dialysis clinics. That planning is now underway.
“Planning for prevention is on-going, and dialysis is a major component of that effort,” said Dr. Richard Melchreit, Healthcare Associated Infection Program coordinator at the State Department of Health. Collaborating with the Network of New England, the health department is collecting reliable data that can be tracked over time.
The next step, according to Melchreit, is to develop a prevention education plan. One idea that’s being considered is to produce a Web-based seminar that can be viewed by healthcare providers without having to leave work.
“Dialysis clinics, other hospital wards, settings besides the intensive care unit is where we need to put our emphasis next,” said Melchreit. “I really think we’re on top of the wave with this.” The state is aiming to release a report on central line infections by the end of the month.
Frieden is confident that through careful data collection and collaboration between federal, state and local healthcare stakeholders, hospital associated infections can be significantly reduced. “This is one of those places where we can not only improve the quality of medical care but save a significant number of lives and a significant amount of money.”
As a Dialysis Patient Safety Advocate, I have been trying to six years to have ALL dialysis facilities participate in the CDC’s NHSN program, however, the number of participating facilities is low, except for Colorado, the only state that mandates reporting.
I am in California and have posted to our website http://www.qualitysafepatientcare.com the surveys for 2010. It is clear that problems with delivery of care to prevent infections needs major intervention and providers need to revisit their training/educational programs as well as their unit-level supervision. For example, out of 25 surveys conducted the first part of 2010, 23 had deficiencies cited in infection control, with some very major citations e.g. Conditions NOT met. Considering infection has been the number two killer of this vulnerable population for more than ten years, one would think that there would be a decrease in the number of deficiencies cited for lack of implementing correct practices. Evident, also, is that staff were not following their OWN FACILITY’S policies/procedures.. SHAME.. There is NO public reporting for dialysis facilities in this area except for that which I mentioned above.
Roberta Mikles, BA RN
uncompensated dialysis patient safety advocate
Director, Advocates 4 Quality Safe Patient Care