Keeping Germs Out
Problem: Blood infections in patients who have a central venous line Proposal: Diligent hand washing, disinfecting skin regularly, other measures Possible lives saved: 10,000
Walk into an intensive care unit and you're likely to see many of the patients sporting a catheter--a tube about the thickness of spaghetti. The catheters enter their bodies beneath the collarbone and disappear into a blood vessel called the subclavian vein. The catheter is called a central line or central venous line. It could be in place because a patient needs to have large slugs of medications administered regularly or is taking powerful drugs that could harm blood vessels if given intravenously. A central line is a very efficient way to pump antibiotics and other lifesaving drugs directly into the bloodstream.
Unfortunately, inserting a central line is complex and takes time, during which deadly germs can enter the break in the skin. And the line stays in place for some days, during which microbes can take the same direct route--just as a surgical incision can be an open door, and with the same deadly consequences. Tens of thousands of patients--by some calculations more than 300,000--pick up bloodstream infections each year simply by being in the germy hospital environment. And 70 percent of those blood infections occur in patients with a central line, according to a surveillance system that tracks hospital-borne infections. IHI estimates the yearly death toll from blood infections related to catheters to be as high as 28,000.
Washed up. IHI's response in the 100K campaign is a bundle of measures that start with treating the insertion of a line as if it were surgery. That means draping patients with a sterile sheet, and sterile gloves, gown, and mask for the medical team. Even the type of antiseptic used to disinfect the skin is important; IHI specifies chlorexidine.
Every contact by a caregiver with a central-line patient, moreover, must be with clean hands. Traditionally, that has meant heading to a sink for a round of soap and water. Doctors and nurses, unfortunately, tend to be something less than diligent about hand washing. At one hospital, caregivers were observed and asked how faithfully they and their coworkers wash their hands after touching a patient. They do so 85 percent of the time for themselves, they responded, but their coworkers comply only 51 percent of the time. In fact, according to the observers, the caregivers washed up only 28 percent of the time.
It's no surprise. Hand washing takes 30 seconds to 2 minutes, according to studies. Multiply that by a large number of patients over the course of a day. And caregivers frequently forget as they hurry from patient to patient, distracted by interruptions. In 2002, the Centers for Disease Control and Prevention issued guidelines calling for use of alcohol-based rubs, which require only 10 to 30 seconds to work in, except when the hands are visibly dirty. Both Hackensack and McLeod have installed large numbers of dispensers of alcohol-based gel.
This story appears in the July 18, 2005 print edition of U.S. News & World Report.