07 April 2009
New Medical Protocol Aims to Prevent Bloodstream Infections
Program, successfully tested in Michigan, being expanded to other nations
Baltimore — Hospitals are havens of healing, but they also house dangerous germs that can and do infect patients. Hospital-acquired bloodstream infections are common, deadly and, according to research, preventable. Dr. Peter Pronovost has developed a program to help prevent bloodstream infections and is sharing it with the world.
Catheters — tubes placed into a neck, chest or groin blood vessel — can deliver medication and fluids to — or provide a blood sample from — patients in a hospital, but they also can introduce dangerous bacteria directly into a patient’s bloodstream. According to Pronovost, a professor at the Johns Hopkins University Bloomberg School of Public Health and director of the Johns Hopkins Quality and Safety Research Group (QSRG), 80,000 patients become infected through a catheter each year in the United States with around 30,000 deaths. At a cost of $45,000 per infection, the annual expense of these infections could reach $2.3 billion, according to the U.S. Centers for Disease Control and Prevention (CDC).
The impact these infections have globally is unclear. “Most other countries aren’t measuring bloodstream infections. A crucial first step is that we want to know how big of a problem we are dealing with,” Pronovost said. “But even in developing countries this might be an issue.”
The World Health Organization is teaming up with QSRG to bring the Comprehensive Unit-based Safety Program (CUSP) to Spain, Peru and Chile beginning in April. Representatives of the United Kingdom are working directly with QSRG to introduce CUSP to their nation, also in April.
CUSP, a collaborative effort among QSRG, the Health Research and Educational Trust and the Michigan Health and Hospital Association’s Keystone Center for Patient Safety and Quality, ran throughout Michigan for 18 months and reduced catheter-related bloodstream infection rates by 66 percent, saving an estimated 2,000 lives and $200 million.
“This is by far the largest, most robust and sustained improvement we’ve seen [in bloodstream infection rates], and people are hungry for things that work,” Pronovost said. Because of the dramatic reduction in infection rates observed in Michigan, CUSP is expanding. On February 1, the program was rolled out in 30 other states.
STUDY SHOWS CATHETER-RELATED INFECTIONS ARE PREVENTABLE
It was not always clear that it was possible to prevent catheter-related bloodstream infections. “We thought for years that these infections were inevitable,” Pronovost said, but the Michigan study shows that they are not. At the heart of CUSP’s success is simplifying complicated and lengthy patient-safety guidelines. “What was needed was summarizing evidence in a simple checklist. Turn a 100-page document into just five different things.”
By following a short protocol — essentially a checklist — each time a catheter is placed, health care providers appear to use good technique more often. The checklist is five steps: Wash your hands; clean the patient’s skin; put on a cap, gown and mask; avoid placing the catheter on groin; and take out lines when you do not need them. But the checklist is only part of the program.
“CUSP is a system that allows doctors and nurses to help each other out,” Pronovost said. “It gives them tools to practice teamwork behavior and to set goals every day.”
The first step in the program is educating hospital staff on the science of safety, using materials provided by Pronovost. Then, teams made up of hospital staff members work to identify defects in their hospital and come up with interventions to improve outcomes. After implementing an intervention, the team monitors the results to determine whether it has developed a viable solution. “At the end of the day, the monitoring is most important,” Pronovost said.
In addition, CUSP is flexible, and could be useful in stemming the rates of any hospital-acquired infection, according to Pronovost. Bloodstream infections can enter the body through routes other than catheters, and other types of diseases, like pneumonia and Methicillin-resistant Staphylococcus aureus (MRSA), can be spread in hospital settings.
Any hospital can follow the CUSP protocol. “We’ve put all the training materials online,” Pronovost said. “We have a Web site with these modules that will be free and open to the public with all components to this program.”
“It’s time we improve health and safety,” he said.
Additional information on the CUSP approach to improving patient safety is available on the Web site of the Johns Hopkins Bloomberg School of Public Health.
