U.S. hospitals in 2011 showed improvements in their rates of central line-associated bloodstream infections (CLABSI) and in some surgical-site infections, compared with 2010, but the rate essentially hit a plateau for catheter-associated urinary tract infections (CAUTI), according to a new CDC report.
“Reductions in some of the deadliest healthcare-associated infections are encouraging, especially when you consider the costs to both patients and the health care system,” CDC director Thomas R. Frieden, MD, MPH, says. “However, the slower progress in reducing catheter-associated urinary tract infections is a call to action for hospitals to redouble their efforts to track these infections and implement control strategies we know that work.”
The report showed a 41% reduction in 2011 central-line infections compared with 2008, the baseline year for the report. In 2010, the reduction was 32% over the 2008 baseline. The improvement was seen across ICUs, general wards, and neonatal ICUs.
—Scott Flanders, MD, SFHM, professor of medicine, director of hospital medicine, University of Michigan Health System, Ann Arbor, former SHM president
The CDC also reported a 17% drop in surgical-site infections since 2008, better than the 7% reduction in 2010. The biggest reductions were seen in coronary artery bypass graft surgery and cardiac surgery; little improvement was seen in infections from hip arthroplasty and vaginal hysterectomy procedures.
The rate of infections from CAUTIs was 7%, nearly the same as the 6% rate in 2010 data. The infection rate in ICUs actually went up—a 1% drop in 2011 compared with a 3% drop from baseline in 2010.
SHM is a partner in two initiatives that aim to reduce CAUTI infections: the University HealthSystems Consortium’s Partnership for Patients project and On the CUSP: STOP CAUTI, an American Hospital Association HRET effort that’s funded by the Agency for Healthcare Research and Quality-funded project.
Gregory Maynard, MD, SFHM, director of hospital medicine at the University of San Diego Medical Center and senior vice president of SHM’s Center for Healthcare Improvement and Innovation is encouraged by the CLABSI and SSI figures. The report highlights the need for more effort on CAUTI.
He also says it was telling that the CAUTI numbers were worse in the ICU than in general wards.
“The more complex the environment, the easier it is for those things to get lost,” he says. “It just will probably take more attention to it and making it more of a priority.
“The more complex the environment, the easier it is for those things to get lost. It just will probably take more attention to it and making it more of a priority…. We’re supposed to reduce these adverse events by a very significant amount and obviously we’re not getting there based on this report. We have to do a better job. Reducing CAUTI by 40% is one of goals for the $500 million Partnerships for Patients effort. With that much money involved, it should increase the pressure to get this done.”
Scott Flanders, MD, SFHM, a former SHM president and SHM’s physician leader for STOP CAUTI, says the report shows that CAUTIs may be more difficult to prevent. In part, that is because catheters are used more broadly throughout a hospital than, say, central lines, which are most common in ICUs.
It takes a multi-disciplinary team implementing a variety of tools: critieria for putting catheters in, managing them appropriately once they are in, and developing protocols for removing them as quickly as possible, he adds.
“Having all those elements in place are critical to preventing CAUTI and I think many hospitals around the country have not implemented all of those strategies to reduce CAUTI,” says Dr. Flanders, professor of medicine and director of hospital medicine at the University of Michigan Health System in Ann Arbor. “No single strategy used in isolation is going to be effective.”
Efforts to reduce CAUTIs have been launched more recently than efforts to reduce other infection types, he says.
“There’s been less of a drive for CAUTI,” he says. “It’s a tougher problem to tackle than some of these other issues, which is a contributing factor in the lower rate of improvement.” TH
Tom Collins is a freelance writer in South Florida.