Researchers from the Columbia University School of Nursing found that approximately one in 10 hospitals lack checklists to prevent bloodstream infections, and one in 4 lack checklists to help avoid pneumonia in ventilator patients. Even worse, these checklists are followed only about half of the time.
While most hospitals have polices in place to prevent HAI infections, clinicians often fail to follow evidence-based guidelines established to prevent these infections. The study investigated compliance with evidence-based policies to prevent infection in 1,653 ICUs at 975 hospitals nationwide.The study focused on three of the most common preventable infections – central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections. For central-line associated bloodstream infections, or CLABSI, the study found that more than 90 percent of ICUs had checklists for sterile insertion but the policies were followed only about half of the time. Catheters, also known as a central line, deliver life-saving medicines and nutrition. Without proper insertion, utilization, and maintenance, catheters can also transmit deadly infections to the bloodstream. Simple infection prevention measures include hand washing before handling the catheter and immediately changing the dressing around the central line if it gets wet or dirty.
Compliance rates were no better for preventing ventilator-associated pneumonia, or VAP, the study found. Overall, three in four ICUs had checklists for protecting against infections linked to ventilators, machines that force air into the lungs when patients can’t breathe on their own. The ICUs followed their own checklists just half the time. Keeping patients elevated in bed, with the head higher than the feet, is one simple precaution that can help prevent pneumonia.
Patients with urinary catheters fared even worse, the study found. Guidelines to prevent catheter-associated urinary tract infections, or CAUTI, are newer, and there aren’t universally accepted checklists to follow at the bedside. About one third of hospitals had no prevention polices in place to prevent these infections. Even at hospitals that did establish some guidelines, the measures were followed less than 30 percent of the time.
Health care-associated infections kill an estimated 100,000 Americans a year and create approximately $33 billion in excess medical costs. The U.S. Centers for Disease Control and Prevention first linked infection rates to prevention programs in the 1970s. Research since then has shown that checklists and other targeted infection control practices can make a significant dent in infection rates – but only if compliance rates among clinicians are also high.