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Central Line Infections in ICUs Down But Progress Needed Elsewhere

By Dena Bunis, CQ HealthBeat Managing Editor

March 1, 2011 -- Collaborations between hospitals and public health officials at all levels have led to a sharp decline in the number of bloodstream infections in intensive care unit patients with central lines. Such efforts now need to be expanded to include patients who get care in other settings, say officials at the Centers for Disease Control and Prevention (CDC), commenting Tuesday on the release of a new Vital Signs report.

The report showed that ICU central line infections decreased by 58 percent from 2001 to 2009. It also says that the reduction represents a savings of as many as 27,000 lives and $1.8 billion in excess health care costs. According to the CDC, bloodstream infections in patients with central lines can kill as many as one in four patients who get one.

Beyond the ICU findings, the report estimates that about 60,000 bloodstream infections occurred in patients with central lines in non-ICU health care settings such as hospital wards and kidney dialysis clinics. About 23,000 of these occurred in non-ICU patients in 2009 and about 37,000 infections occurred in dialysis clinics patients in 2008.

“What this shows is when you have clear evidence-based practices and you have a way to measure the outcome, progress can be made, especially when the government and the CDC focus on it,’’ said Donald Goldman, senior vice president at the Institute for Healthcare Improvement in Cambridge, a professor of pediatrics at Harvard Medical School and of immunology and infectious diseases at the Harvard School of Public Health.

Goldmann said this problem of infections from central lines has been known for some time and that beyond the federal push to contain it many states now have mandatory reporting for this type of infection.
Translating the ICU success to inpatient hospital wards and dialysis clinics will be somewhat tougher, he said. "The evidence is still accumulating. Dialysis patients are tough," he added, “because those catheters are in for a long time and it’s tough to control those infections."

Infections are one of the leading causes of hospitalization and death for hemodialysis patients, CDC officials say. At any given time, about 350,000 people are receiving hemodialysis treatment for kidney failure. Seven in 10 patients who receive dialysis begin that treatment through a central line.

“Preventing bloodstream infections is not only possible, it should be expected,’’ said CDC Director Thomas R. Frieden. “Meticulous insertion and care of the central line by all members of the clinical care team including doctors, nurses and others at the bedside is essential. The next step is to apply what we’ve learned from this to other health care settings and other health care–associated conditions, so that all patients are protected.”

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