No single intervention alone appears to be sufficient to significantly reduce CRBSI rates. Therefore, the guideline recommends “bundling” several of these individual best practices into a streamlined approach—inclusive of feedback to healthcare personnel on infection rates and compliance—thereby promoting quality assurance and performance improvement. This bundling tactic makes best practices a priority and a reality, and offers the largest potential impact on the prevention of intravascular catheter-related infections.5
Practical recommendations to assist clinicians in preventing CLABSI also were put forth in 2008 guidelines by the Society for Healthcare Epidemiology of America (SHEA) and Infectious Disease Society of America (IDSA).7 Compared to the SCCM guidelines, these guidelines are more focused on CVCs and do not directly address other available intravascular devices (PICCs, hemodialysis catheters, etc.). Beyond this, the SCCM guidelines also discuss the microbiology of infection, surveillance measures, and the specifics of the performance improvement measures involved in their implementation, which are not found in the SHEA and IDSA guidelines.
Numerous national initiatives and measures have been established based on these and other clinical practice guidelines. The Joint Commission recently produced the new monograph “Preventing Central Line-Associated Infections: A Global Challenge, A Global Perspective,” listing “Use proven guidelines to prevent infection of the blood from central lines” as one of its National Patient Safety Goals.8 The Institute for Healthcare Improvement (IHI) created its Central Line Bundle along with its “How-To Guide: Prevent CLABSI in 2011,” which has been implemented by many hospitals in the U.S. and United Kingdom. The IHI bundle has resulted in dozens of hospitals achieving more than a year of no CLABSIs in their ICU patients, and many have expanded the program to other areas of the hospital.9
Giving further impetus toward efforts to prevent these complications, the Centers for Medicare & Medicaid Services (CMS) determined that vascular-catheter-associated infections are hospital-acquired conditions that will no longer be reimbursed, as outlined in 2008 in the Acute Inpatient Prospective Payment System.10 Therefore, hospitals will not receive additional payment for these infections acquired during hospitalization (i.e. was not present on admission), and the case is paid as though the costly infection were not present, thus aligning improved patient care and outcomes with the financial bottom line for hospital reimbursement.
Given the significant economic and clinical burden of intravascular-device-related infections, hospital staffs should be aware of and adopt proven interventions to minimize this important complication. No one single intervention can meaningfully impact this infection rate, but a “bundled approach” appears to be the most influential.
Dr. Rohde is a hospitalist and assistant professor of internal medicine and Dr. Hartley is a hospitalist and clinical instructor of internal medicine at the University of Michigan Hospital and Health Systems in Ann Arbor.