Aggressive Negotiations


Hospitalists are in position to take a leading role in the prevention of catheter-related bloodstream infections (CRBSIs), according to a spokeswoman for the Association for Professionals in Infection Control and Epidemiology (APIC).

The APIC perspective is timely, as the group released a survey this summer that found hospitals continue to struggle with preventable hospital-associated infections (HAIs). Half the survey respondents said their institutions struggle with CRBSIs and blame lack of time, resources, and a lack of administrative initiative as “hindering their ability to combat these infections more aggressively.”

The push also comes as a new Centers for Medicare and Medicaid Services rule means that, beginning next year, central-line-associated bloodstream infections (CLABSIs) will be reported and posted on a CDC website. The public disclosure of such preventable infections should motivate physicians to more aggressively address the problem, according to the APIC.

“Hospitalists need to be the champions,” says Sharon Jacobs, RN, MS, CIC, manager of infection prevention and control at St. Clair Hospital in Pittsburgh.

To that end, Jacobs offers some tips on how hospitalists and others can help stem the tide of the estimated 80,000 patients a year who develop CRBSIs. They include:

  • Hand hygiene: The use of gloves during procedures does not mean physicians should forgo washing their hands.
  • Large drapes: Most vendors now include drapes in their line kits, but for those that might not, consider using the largest drape available to cover and protect as much of the patient as possible. Consider creating a cart to store all applicable equipment.
  • Focus on care continuum: Insertion of a line is the first step. Make sure the line is properly maintained as long as it remains in the patient. Consider replacing lines hastily inserted in the ED or other departments. Remove all lines as quickly as clinically efficient.

Another key, Jacobs says, is to create a collaborative environment where hospitalists, intensivists, nurses, and others will feel encouraged to point out improvements instead of feeling chastised for pointing out potential errors.

“The mindset is changing,” she adds. “It doesn’t take any longer to follow these procedures than it does to put a line in without them.”

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