Catheter-associated bloodstream infections: is it possible to get to zero?
by Lillian Burns, MT, MPH, CIC
           

Healthcare organizations, realizing the significant impact of catheter-associated bloodstream infections (CABSIs) on the patient and the bottom line, have undertaken measures to prevent the occurrence of such infections, particularly those that originate with central venous catheters (CVCs). To reduce CABSIs, some organizations have implemented the Institute for Healthcare Improvement’s central line bundle,1 a grouping of evidence-based recommendations that, when implemented together, have been shown to reduce infections. The components of the bundle include hand hygiene, chlorhexidine skin antisepsis, optimal site selection, use of maximal barrier precautions during catheter insertion, and prompt removal of catheters when no longer needed. Other healthcare organizations use intravenous-therapy teams, composed of specially trained nurses, to manage catheter care. These efforts have resulted in a decline in the number of catheter-associated bloodstream infections. In some cases, healthcare organizations are reporting zero CABSIs. How is it possible to achieve zero CABSIs after years of sustained CABSI rates?

The process began as the general public, regulatory agencies, and patients increasingly focused on healthcare-associated infections (HAIs). Healthcare organizations have looked within for solutions, particularly for HAIs that result in increased morbidity, mortality, and healthcare costs. Bloodstream infections are associated with significant mortality and higher costs.2 A number of states have passed legislation requiring healthcare organizations to report CABSIs, and hospital infection rates are posted on the Web, allowing the public to make comparisons among healthcare organizations and exert pressure on them to improve. As part of the Federal Deficit Reduction Act, the Centers for Medicare & Medicaid Services (CMS) has revised the reimbursement criteria for cases of hospital-acquired infection and will no longer reimburse for certain preventable hospital-acquired complications, including CABSI. These changes impact a healthcare organization’s bottom line, so is it any wonder that these organizations are striving to get to zero infections? The results are impressive, and some inspiring success stories are recounted towards the end of this document.
           

The issues surrounding catheter-associated bloodstream infections are complex and warrant close examination.