Johns Hopkins study shows hospitals can prevent one in five central-line infections
BALTIMORE - According to a new Johns Hopkins Children's Center study, hospitals can prevent one in five central-line infections by following a list of precautions and measures, encouraging families to speak up when they observe noncompliance and doing an analysis of the causes behind every infection that does occur.
In the study, which was published in the October issue of Pediatrics, the hospital reports that conducting what their researchers call a "triple threat" approach to using a central venous catheter, or central line, contributed to a reduction in infections by 20 percent over a two-year period. During year one, the infection rate remained unchanged, but in the second year, infections plummeted by 64 percent.
Michael Rinke, an author of the study and an assistant professor of pediatrics at Johns Hopkins University School of Medicine, says 250,000 central-line infections occur in the U.S. each year, and each infection can cost hospitals $25,000.
Rinke said that in November 2009, Johns Hopkins Children's Center joined a 27-institution quality transformation effort organized by the Children's Hospital Association to focus on reducing central-line infections. Those institutions involved in the collaboration used a bundle system addressing all areas of central-line infections that included over 40 best practices for every time a nurse or doctor accesses a central line or changes dressings.
According to Rinke, in order to cut down on infections, nurses deployed strict device-handling precautions that included frequent and regular changing of the dressing covering the central line; regular changing of the tubes and caps attached to central line; cleaning of the line before and after each use; use of facial masks and gloves when handling the device; and hand-washing before and after handling the line. Additionally, the Johns Hopkins researchers asked parents to provide additional oversight, equipping them with wallet flash cards on the "dos" and "don'ts" of central-line care.
Kim Drucas, a nurse clinician in the pediatric oncology unit at Johns Hopkins, said the nurses in the unit now have a "heightened sense of awareness on the central line and how to keep it safe."
"The nurses like using the system and come to me and say they noticed different things about some of the central lines and will tell me when there might be risk for infection," she said.
The Dana-Farber Cancer Institute in Boston has also been involved in the nationwide collaboration to reduce central-line infections.
"The goal in the collaborative and our programs is to say we are going to do our utmost to reduce the total number of infections, but recognizing that it's probably not possible to get rid of them completely," said Amy Louise Billett, director of safety and quality in the pediatric hematology/oncology division at Dana-Farber.
Rinke said the program is really a nursing-led effort and that nurses "deserve 100 percent of the credit."
"The nurses embraced using this bundle. We do weekly audits of our progress and draw a lot of attention every time we have a failure or infection as a way to provide a learning experience and see where change is needed. And we created a culture without blame. It's not that someone did a bad job or is a bad nurse, it's that the system just isn't working," he said. "Nurses are the real champions here and are the ones doing this everyday."
Rinke hopes to see similar programs developed at many more hospitals in the near future.
"I think this will really become the state-of-the-art for how to handle pediatric central lines," he said.