Preventing Hospital Acquired Infections among Elderly ICU Patients Reduces Death Risk, Saves Money

Elderly patients who develop hospital-acquired infections (HAIs) while in intensive care units (ICU) are approximately 35 percent more likely to die within five years than other patients, according to a new study co-authored by INQRI grantee Patricia Stone.

The most common HAIs are bloodstream infections caused by central lines and pneumonia caused by ventilators, reports Advanced Healthcare Network for Nurses. Decreasing the incidents of these two HAIs alone could increase the odds that ICU patients survive, and reduce health care costs by more than $150,000, according to Stone’s study.

Stone and her colleagues examined outcomes for 17,537 Medicare patients over a five year period and found that while 57 percent of all the elderly ICU patients had died, nearly 80 percent of patients who developed HAIs during their ICU stays died.

"Any death from preventable infections is one too many," Stone tells Advanced. "We've known for decades what works to prevent infections and save lives. Now, our study shows just how much money can be saved by investing in prevention."

The paper, "A decade of investment in infection prevention: A cost-effectiveness analysis," was published in the January 2015 issue of the American Journal of Infection Control and was funded by the National Institute of Nursing Research.

Reducing central line infections was the focus of an INQRI-funded study led by David Thompson and Jill Marsteller. Their study, involving 45 intensive care units in 35 hospitals in 12 states, tested a nurse-led intervention that used a bundle of evidence-based practices to reduce infections. The intervention was successful in significantly reducing infections and also highlighted the importance of promoting a culture of safety and communication. It also established that nurses should play a central role in quality improvement interventions.

Patricia Stone’s INQRI-funded project: “The Impacts of Nurse Staffing, Skill Mix, and Experience on Quality and Costs in Long-Term Care” examined whether there is a causal relationship between nursing input and patient outcomes in long-term care (LTC) facilities.

The full Advanced article is available here.

Nurses Can Effectively Use Hospital Approach to Infection Prevention in Dialysis Settings

Safety assessment tools and interventional approaches, such as those used by nurses in hospitals, are also effective in reducing catheter-related blood stream infections (CRBSIs) in outpatient dialysis settings, Nephrology News & Issues reports.

The study, A Pilot Quality Improvement Program to Minimize Catheter-Related Bloodstream Infection in an Outpatient Hemodialysis Setting, was presented at the 45th annual meeting of the American Nephrology Nurses Association. Research was led by Nancy Culkin of DaVita HealthCare Partners, a specialty contract research organization focusing on drug and device development.

The study concludes that approaches which have successfully reduced CRBSIs in hospitals can be applied in chronic dialysis facilities, including procedural kits with materials such as: a checklist, antimicrobial swabs for skin prep, triple antibiotic ointment for onsite application, alcohol swabs to facilitate hub scrub, and exit site dressing.

An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of central line-associated bloodstream infections. The study was conducted by David Thompson and Jill Marsteller, associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton, now at the Duke University Health System Patient Safety Center.

“It’s important to note that this was a nurse-led intervention,” Marsteller said. “The units’ success in reducing infections not only demonstrates the effectiveness of the intervention, but also confirms that nurses can have and should play a central role in quality improvement interventions.”

Infections Drop by nearly 20 Percent with Reduced Blood Transfusions

Reducing the amount of red blood cell (RBC) transfusions performed in hospitals can also reduce infection rates, according to a new study published in the Journal of the American Medical Association.

Researchers from the University of Michigan and the University of Rochester School of Medicine and Dentistry studied 18 clinical trials, comparing those which restricted use of blood transfusions with a more liberal transfusion strategy. They found that incidence of health care-associated infections was 11.8 percent in the restrictive group and 16.9 percent in the liberal group.

The study shows that RBCs can be a more costly and dangerous treatment method than previously believed, according to the researchers.

"Many people are beginning to accept that we can make a difference--despite being taught in medical school that blood transfusions 'might help and can't hurt,'" Neil Blumberg, professor at the University of Rochester School of Medicine and Dentistry tells HealthCanal. "What we've found is actually the opposite, that it can hurt and it rarely helps."

An INQRI-funded study published last year in Critical Care Medicine found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of infections. The study was conducted by David Thompson and Jill Marsteller associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton now at the Duke University Health System Patient Safety Center.

More than a Third of Patients at Community Hospitals Receive Inappropriate BSI Antibiotics

One out of every three community hospital patients being treated for a bloodstream infection (BSI) get inappropriate antibiotic therapy, according to a new study published in PLoS One and reported on by FierceHealthcare. The research was led by Deverick J. Anderson, MD, a Robert Wood Johnson Foundation Physician Faculty Scholars alumnus.

Researchers conducted the study on nearly 1,500 adult patients with BSIs at nine community non-academic hospitals in North Carolina and Virginia from 2003 to 2006. Hospital staff gave more than one in three (38 percent) of the patients studied inappropriate antibiotics, according to researchers. Most of the infections analyzed in the study were health care associated, according to the study abstract.

MedPage Today, Infection Control Today and HealthDay News also reported on Anderson’s findings.   

An INQRI-funded study found that a nurse-led intervention combining a “bundle” of evidence-based practices with a comprehensive safety program dramatically reduced the mean rate of bloodstream infections. The study was conducted by David Thompson, DSNc, MSN, RN, and Jill Marsteller PhD, MPP, associate professors at Johns Hopkins University in the School of Medicine and Bloomberg School of Public Health, respectively, and by J. Bryan Sexton, PhD, now at the Duke University Health System Patient Safety Center.

Study Links RN Perception of Work Environment to Rates of Infection

Healthcare-associated infections (HAIs) are less likely to occur in favorable critical care work environments, according to a study of more than 3,200 nurses, Nurse.com reports. The principal investigators for the study were INQRI NAC member Linda H. Aiken and INQRI researcher Eileen Lake.

HAIs cost the health care system billions of dollars each year, according to background information for the study, which was published in the November issue of the American Journal of Critical Care. The study found nurses working in favorable critical care environments were 36 to 41 percent less likely than nurses in poor work environments to report that urinary tract infections, ventilator-associated pneumonia, and central line-associated bloodstream infections occurred more than once a month. The study also finds that critical care nurses are well-positioned to reduce the prevalence and prevention of HAIs in critically ill patients.

An INQRI team led by Eileen Lake and Jeannette Rogowski demonstrated the impact of nurse staffing and the professional practice environment in preventing infection among infants in neonatal intensive care units (NICUs). Their findings show that babies in units where nurses have less support and limited professional practice are at higher risk of developing infections. Higher levels of NICU experience are associated with better infant outcomes.

International Infection Prevention Week 2013

October 20-26 is International Infection Prevention Week (IIPW), sponsored by the Association for Professionals in Infection Control and Epidemiology (APIC).  APIC leads this annual effort to highlight the importance of infection prevention to improve patient outcomes.

In honor of IIPW 2013, APIC is launching the Infection Prevention and You campaign with free online resources to encourage health professionals to spread the word about the dangers of lack of infection prevention in healthcare settings. In addition, research studies on infection prevention are available in APIC’s American Journal of Infection Control. The October 2013 Journal features a study on the quality of publicly reported central line-associated bloodstream infection data in Colorado.

Previous studies in Colorado found significant under-reporting of central line-associated bloodstream infections, which led the Colorado Department of Public Health and Environment to perform onsite validation visits to assess surveillance practices and retrospective chart reviews of patients in ICUs with positive blood cultures during the first quarter of 2010. They found wide variation in surveillance practices and in application of definition criteria. The study revealed that infections were under-reported by 33 percent and the authors concluded that the Department of Public Health and Environment should validate self-reported healthcare-associated infection data.

An INQRI study out of Johns Hopkins University was the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. The study was conducted in ICUs in 12 states and nurses led the infection control efforts. Measured 19 months after implementation, infection rates were reduced by 81 percent. The project findings are presented in a research brief on RWJF's website. David Thompson and Jill Marsteller led the research.

Research Brief: Reducing Blood Stream Infections

The next grantee project in our series comes from Johns Hopkins University.  Led by David Thompson and Jill Marsteller, the team's goal was to implement a comprehensive safety program including an evidence based intervention to reduce central line-associated blood stream infections (CLABSIs) while examining the context of nursing care delivery on patient outcomes. This interdisciplinary research team used the expertise of nurses to develop and deliver a quality improvement initiative that reflects the positive clinical contributions of nurses in the critical care setting. This study is likely to inform other nurse-led medical error reduction interventions, contribute to the quality improvement literature and to the science of rigorously evaluated evidence based interdisciplinary nursing practice.

Access the research brief.

Access a chart on the quarterly number of perceived CLABSI prevention practices during the implementation period.

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Nurse Burn-Out and Infections

A new study, published in the American Journal of Infection Control, presents the work of researchers at the University of Pennsylvania, who analyzed nurses' attitudes related to their work.  The team compared a hospital's percentage of "burned-out" nurses to its rates of surgical site infections and catheter associated urinary tract infections.  They found that every 10% increase in the number of high-burnout nurses correlated with two additional surgical site infections and one additional catheter associated urinary tract infection per 1,000 patients annually.

The INQRI program has also generated evidence that depression among nurses could have an impact on patient safety.  INQRI researchers Sue Letvak, Chris Ruhm, and their team evaluated the influence of presenteeism (decreased productivity due to health problems) on hospital registered nurses' quality of patient care.  The team found that pain and depression were significantly associated with presenteeism and that presenteeism was significantly associated with patient falls, medication errors and the perceived quality of care.

Of course, INQRI research has also shown that nurses can have a strong impact on keeping patients safe from infections.  Led by David Thompson and Jill Marsteller, a team at Johns Hopkins conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. This study, conducted in ICUs in 12 states, has shown that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts.

An INQRI team led by Eileen Lake and Jeannette Rogowski has demonstrated the importance of nurse staffing and the professional practice environment in preventing infection among tiny babies in neonatal intensive care units (NICUs). Their findings show that babies in units where nurses have less support and limited professional practice are at higher risk of developing infections. Higher levels of NICU experience are associated with better infant outcomes.

Universal Treatment for MRSA in ICUs Is More Effective in Preventing Infections

A study published online this week in the New England Journal of Medicine finds that treating all patients in intensive care units (ICU) for drug-resistant MRSA is more effective in preventing bloodstream infections than screening all patients and isolating those who test positive, which is the most common practice.

The study included nearly 75,000 patients in 74 ICUs in 43 hospitals. Researchers found that treating all patients (universal deconolonization) reduced all bloodstream infections, including those caused by bacteria other than MRSA, by 44 percent. The group of patients who were first screened and isolated if they tested positive for MRSA showed no significant decrease in infections and the gruop of patients who were screened and treated for MRSA if they tested positive showed only a 22 percent reduction in infections.

The treatment involved washing patients with cloths containing antimicrobial soap chlorhexidine and giving them mucipirocin, a nasal antibiotic ointment.

The 43 hospitals in the study were all part of Hospital Corporation of America, which is now implementing the protocol in all its hospital ICUs.

The study notes that widespread use of chlorhexidine and mupirocin could engender resistance.

An INQRI-funded study led by David Thompson and Jill Marsteller, published in Critical Care Medicine found that combining several tested and proven practicies for preventing central line associated bloodstream infections (CLABSIs) with a program to improve safety, teamwork and communications, dramatically reduced infection rates.