"Preventing Bloodstream Infections is not only Possible, It Should be Expected"

By Peter Laird, MD

The CDC recently announced the dramatic news that catheter based infections in the ICU's across America since 2011 are greatly reduced by the use of "Bundled" protocols of catheter insertion and preventive care saving over 1.8 billion in the last decade alone. One of the central factors to the success of the bundle is peer pressure from public reporting of each physicians outcomes.  

  

However, dialysis units have not shared this success despite the fact that bundled central lines in the ICU have been the standard of care for several years.

CDC: Too Many Infections in Dialysis Clincs

"Preventing bloodstream infections is not only possible, it should be expected,” said Thomas R. Frieden, MD, MPH, CDC director. “Meticulous insertion and care of the central line by all members of the clinical care team including doctors, nurses and others at the bedside is essential. The next step is to apply what we've learned from this to other healthcare settings and other healthcare-associated conditions, so that all patients are protected.”

The CDC is now targeting blood infections in the dialysis unit in the same manner as their program against cather associated infections in the ICU over the last several years.  The steps to prevent infections are quite simple and proven over hundreds of years beginning with the simple procedure of washing your hands before doing any patient care. Unfortunately, the record on hand washing in American dialysis units is abysmal.  

I am pleased to see this new focus on dialysis related infections which if implemented widely shall significantly reduce the pain and suffering of dialysis patients at the hands of those they trust with their lives simply because they don't care enough to wash their hands or change gloves between patients. As in many issues, simply taking the time to treat your patients in the same manner as you would expect is the beginning of professional health care. It is time to remember these simple truths.

Comments

[roberta mikles]

Peter, thanks for posting this. As an advocate and involved in prevention of infections, I would suggest that your readers visit our site to see the California dialysis faciity survey (inspection reports). These survey findings clearly tell a story. A story that support my opinion that there is a lack of unit-effective supervision of staff to ensure correct pract ices are implemented.There might even be a lack of unit management understanding correct practices. Our website www.qualitysafepatientcare.com again, shows and supports our beliefs that providers must revisit their training, education and preceptor programs. Providers have known, for over ten years, that infection is the number two killer of patients, hence, then WHY are we continuing to see such major deficiencies cited during inspections of facilities? A good question that requires answers. Again, I state, that even up until my father's last two treatments, the treatment before he died, he had to remind staff that the gloves were contaminated. The staff always put on gloves, then touched numerous items, including the face shield worn, etc. Patients should not have to remind staff of the most basic of basic practices. There is NO reason that staff should not be following their own facility policies/procedures related to infection control. There are so many questions to ask: Do staff fully understand the negative consequences of their actions, or lack thereof, when correct practices are not implemented? Are training/education program addressing the seriousness of infections, etc.? Are those precepting new employees implementing correct practices or taking shortcuts? I have been in many units and communicated with patients/families and staff throughout the US who have told me, as well as my own observations, that effective practices are NOT being implemented even when there is time to do such. I have been a strong support for ALL facilities to join the CDC's NHSN program, however, to date, we know that Colorado is the only state that has mandated such and only a handful of facilities have joined. I guess the bottom line, our organization's opinion, is that if staff are educated/trained/precepted correctly and if staff fully understand and are cognizant of negative consequences for patients, but do not implement correct practices, then this is an intentional act to place a patient in harm's way and that these individuals should and can be reported to their agency that either licenses them or certifies them. A harsh statement but if you know what is correct, but you don't do it, it is a choice staff make. To continue to see the numbers of infection control deficiencies cited in the surveys is shameful, truly shameful.
I might also add that patients are still experiencing retaliation, bullying, etc. when they speak out and remind staff of correct practices either infection prevention related, or not. This happens in many units and I continue to work with patients who are experiencing such.
Roberta Mikles RN, Director
Advocates 4 Quality Safe Patient Care
www.qualitysafepatientcare.com

[roberta mikles]

I failed to add that I attended, several months ago, the HHS meeting that focused on targets and metrics for infection in hospitals and dialysis facilities. This was very encouraging and many at the federal level and dialysis provider corporate level want to see change, however, again, until there is effective unit-level supervision, as mentioned above, I might not be as optimistic as others, esp considering the survey findings.
Roberta Mikles RN, Director
Advocates4QualitySafePatientCare
www.qualitysafepatientcare.com
[email protected]