IV Catheter Is Found to Reduce Bloodstream Infections and Treatment Costs

Dr. Leonardo Lorente

A recent study found that a central venous catheter (CVC) designed to reduce bloodstream infections totally eliminated them at a hospital in Spain. The antimicrobial CVC also sharply reduced treatment costs related to the infections, compared to the unprotected CVC matched against it. You can read a study summary here.

The antimicrobial CVC in the study was the ARROW® CVC with ARROWg+ard® Technology. The catheter achieves its antimicrobial effect from a protective layer of chlorhexidine and silver sulfadiazine bonded to the catheter’s surface.

Continue reading “IV Catheter Is Found to Reduce Bloodstream Infections and Treatment Costs”

Expanding Scope of Practice for Vascular Access Specialists Can Improve Quality Care

Part 2 of a two-part post.

Vascular_Access_Team_300pxThe Affordable Care Act (ACA), more commonly known as Obamacare, is 906 pages long. But amidst all that detail are a few driving goals. One of those is something few would argue with: higher quality healthcare at lower cost. That’s also the focus of a new white paper on vascular access.

It’s no wonder the ACA’s authors made that a priority. The U.S. lags behind other industrialized countries on both sides of the quality/cost equation. We have the most expensive healthcare, by far, among industrialized nations, according to both the Organization for Economic Co-operation and Development (OECD) and the healthcare-focused Commonwealth Fund. The U.S. also ranks worse than many of these nations on some measures of quality, including safety.

That brings us to Leslie Schultz, RN, Ph.D., Director of the Safety Institute at Premier, Inc., Continue reading “Expanding Scope of Practice for Vascular Access Specialists Can Improve Quality Care”

How Vascular Access Clinicians Can Help Hospitals Avoid Infection Penalties

Leslie Schultz
Leslie Schultz

At the recent annual meeting of the Association for Vascular Access (AVA), speaker Leslie Schultz, Director of the Safety Institute at Premier, Inc., introduced a provocative idea. Vascular access professionals, she said, can help their employers avoid the substantial financial penalties they face for high rates of central-line-associated bloodstream infections (CLABSIs).

Schultz was referring to the substantial penalties mandated by the Affordable Care Act (ACA), popularly known as Obamacare. The ACA tries to improve healthcare and lower costs by penalizing hospitals that trail most of their peers in preventing infections.

Schultz has a keen sense of the contributions nurses can make to minimizing a hospital’s CRBSI rate. In addition to her role at Premier, she is an RN as well as a Ph.D. Premier’s Safety Institute offers free information, tools, and resources to advance patient safety.

Before diving into how vascular access professionals can leverage their expertise to reduce CRBSIs and the associated penalties, here’s some crucial background. Continue reading “How Vascular Access Clinicians Can Help Hospitals Avoid Infection Penalties”

What Does Healthcare Transformation Mean for Risk Managers?

Susan Carr, editor of Patient Safety & Quality Healthcare, does a good job on the PSQH blog of beginning to answer questions about healthcare risk managers and the transformation of care. Carr discusses comments by futurist Ian Morrison at the annual conference of the American Society for Healthcare Risk Management.

Morrison says the Affordable Care Act isn’t the only factor shaping the changing world of healthcare risk managers. Other influences —consolidation, cost reduction, and realignment of risk—are also crucial.

Morrison’s key issues as outlined in Carr’s article:

1. ) Implementation of the Affordable Care Act and expansion of healthcare coverage to previously uninsured individuals. We may be heading toward two Americas, represented by Texas and California. The difference? The first is one of about half of the states that have refused to expand Medicaid. California, in comparision, has embraced the ACA and expanded Medicaid.

2.) Growth of the individual consumer market in which people have to make many more choices about details of their health insurance: “Morrison believes that individuals’ awareness of the narrow provider networks that come with ‘cheap’ plans is a ‘shoe still to drop.’ “

3.) Realignment of risk. Morrison foresees a country of “100 to 200 large regional systems of care across the country that assume risk on a population basis.”

4.) The changing business model for hospitals and health systems. That means more price pressure, along with an emphasis on value-based purchasing. “Morrison believes this shift ultimately means that hospitals will go from being in the business of filling beds to the business of emptying beds” – while trying to remain financially viable.

5.) Implementing and sustaining a culture of low risk and high quality is critical, and we’re not there yet. It will, he said “make the difference between life and death, between affordability or not.”

More from Carr’s article here.


CMS Publishing Bloodstream Infection Rates at Hospitals

The U.S. Department of Health & Human Services (HHS) has started to publish, for the first time ever, data showing how hospitals nationwide compare in their rates of central line-associated bloodstream infections (CLABSIs) in their intensive care units (ICUs). The public can view the rates on HHS’ Hospital Compare website when deciding which facility they want to patronize. The data will be updated quarterly, with rates for other infections added in the future.

Will this be a game-changer? It very well might be. It comes on the heels of other incentives the feds have used to get hospitals to lower their CLABSI rates, so the new effort could create a tipping point. Here are the previous initiatives:

* In October 2008, the federal Center for Medicare and Medicaid Services (CMS) ceased reimbursing hospitals for a number of hospital-associated conditions, including CLABSIs, that it considered preventable.

* CMS lowered the financial boom again about two years later. As we reported here, CMS mandated that to get full Medicare payments, hospitals had to report CLABSIs and certain other healthcare-acquired infections (HAIs) on the CDC’s National Healthcare Safety Network (NHSN).

The reporting to NHSN began in January 2011, and it is that data that is being shared on Hospital Compare. Although the reporting is voluntary, most hospitals participate for obvious reasons – it would be unthinkable to suffer lower Medicare payments. By the way, much of the credit for these government crackdowns goes to Consumers Union, which for years has been pushing for action on HAIs through its Safe Patient Project.

Of course, Hospital Compare is going to keep some hospital CEOs up at night.

Undoubtedly, savvy patients will penalize facilities with high CLABSI rates when they go hospital hunting. Some CEOs complain that a simple comparison of CLABSI rates puts their institutions at an unfair disadvantage. We’re sympathetic to that claim in some cases. We’ve worked with several hospitals whose patient populations are unusually vulnerable to CLABSIs.

For example, we’ve written about one well-regarded children’s hospital that nevertheless has much higher-than-usual CLABSI rates because many of its patients suffer from short bowel syndrome and also receive total parenteral nutrition. Both issues significantly increase CLABSI risk.

But note that this hospital was still able to lower its CLABSI rates dramatically by taking several preventive steps, including implementing an alcohol-dispensing disinfection cap called SwabCap® that improves disinfection of IV connectors. Disclosure: (We represent SwabCap’s maker, Excelsior Medical.)

Numerous hospitals that were struggling to reduce their CLABSIs achieved sharp reductions when they adopted the disinfection cap, which smartly addresses the problems with the traditional approach to disinfecting connectors.

So, yes, Hospital Compare will sometimes compare apples to oranges, but hospitals can and should reduce infections by implementing best practices and evidence-based technologies like the disinfection cap.

Average hospital CLABSI rates have dropped some over the years, thanks in part to campaigns by the feds, Consumers Union, and other concerned organizations. Consider, though, that many experts believe CLABSIs can be completely eliminated. If they’re right, there’s still room for improvement.

Wise Foundation Receives Grant from Association for Vascular Access

One of the pleasures of working in healthcare PR is the opportunity to work with nonprofit organizations. We’ve done this in the fields of breast cancer, prostate cancer and vascular access.

Having worked previously for the Association for Vascular Access (AVA), last year we began supporting the efforts of AVA’s research and education arm, the Wise Foundation.

AVA and the foundation ended the year on a high note, with the announcement of a major grant from AVA to the foundation. The $50,000 grant, given in honor of AVA’s membership, underlines AVA’s support for the foundation’s mission. The grant also strengthens the foundation’s outreach to other major funders.

For more on the grant and the foundation’s work, see Wise Foundation Grant from AVA. Additional info on the foundation and a current grant opportunity available at http://www.wisefoundation.net.

Study ID’s Potent IV Weapon To Prevent Bloodstream Infections

When one or two hospitals get good results with a new method for preventing infections, it’s “interesting.” When 12 do, it’s time to call the method “important.”

Which is the conclusion Gregory Schears, M.D. of Rochester, Minn. reached about his study of 12 diverse hospitals that trialed SwabCap®, a disinfection cap that is used to passively disinfect the top and threads of needleless IV connectors. Excelsior Medical, SwabCap’s maker, is a Dowling & Dennis client.

Speaking at the annual meeting of the Association for Vascular Access (AVA) – and in a follow-up clinical webinar Dr. Schears said that a disinfection cap should be considered as part of best practice protocols for eliminating central line-associated bloodstream infections (CLABSIs), which kill some 30,000 U.S. patients a year according to the CDC.

You can see Dr. Schears talking about the study here: disinfection cap video. There’s also a free webinar by Dr. Schears that provides more detail on his research, available under “Videos,” here.

How did Dr. Schears reach his conclusions?

Traditionally, nurses disinfect a needleless IV connector manually before accessing the catheter line to draw blood or administer medications or nutrition. The usual method involves scrubbing the connector with an alcohol wipe for 15 seconds, then waiting another 30 seconds for the alcohol to dry before entering the line.

Because the method has several steps, takes at least 45 seconds to do correctly, and often must be done many times a day, busy nurses often cut short the time or skip it entirely. Compliance with 45-second “scrub the hub” protocol is also almost impossible to monitor: What hospital can afford to have someone trail every nurse as she goes about her rounds?

The potential for slip-ups with this method is widely believed to be an obstacle to reaching zero CLABSIs.

The SwabCap disinfection cap, which dispenses alcohol when it is pushed and twisted onto the connectors’ threads, addresses the problems with manual disinfection. It goes on in a few seconds. It twists on just one way, like a lid on a jar, which eliminates variance. Its bright orange color handles the compliance issue, because when it is observed in place, compliance is verified.

It also does two things manual disinfection cannot. Because it creates a seal at the base of the threads, the connector top and threads are continually bathed in alcohol between line accesses. Also, prolonged contact with alcohol is proven to improve disinfection. Moreover, when the cap is in place, it is protecting against touch and airborne contamination.

The hospitals that trialed the disinfection cap in Dr. Schears’ study wanted to test whether it could produce lower CLABSI rates than with manual disinfection alone. The cap’s effectiveness was measured by comparing CLABSI data from the eight-month span prior to the cap’s implementation to the eight months following implementation. This retrospective overview encompassed some 92,000 catheter days – a large number for this kind of study.

The cap made a remarkable difference. The average CLABSI rate reduction at the twelve institutions was 61.6%, which is statistically significant (p<0.0020). The hospitals in the study covered the gamut, from medical to surgical to intensive care in both community hospitals and tertiary care facilities.

For years, a nationwide public-private effort has focused on diminishing CLABSIs, but progress has been spotty. The Schears study suggests that a far greater impact might be achieved if more hospitals adopted disinfection caps. Everything we’ve seen about this device – and the study is just the latest in a constant flow of strong results – points in the same direction.

You can see Dr. Schears talking about the study here: disinfection cap video.

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Patient Safety and Educating IV Nurses

As nurses have more demands placed on them to ensure patient safety, effective tools for educating nurses become increasingly important.

After all, how can we expect nurses to handle sophisticated technology in the most effective way, if we don’t do a good job of teaching them and involving them in the learning process?

One new tool for that educational process, when it comes to vascular access and infusion therapy, is an infographic recently presented as a scientific poster at the annual conference of the Association of Professionals in Infection Control and Epidemiology (APIC).

You can view a brief video about the infographic — which features a disinfection cap for protecting needleless IV connectors from contamination — on the PICC Excellence website of presenter Nancy Moureau, RN, BSN, CRNI, CPUI, here.

INS 2011

The annual meeting of the Infusion Nurses Society attracted hundreds of nurses from all over the  world for  its May gathering in Louisville, Ky.  With Medicare no longer reimbursing for hospital-acquired infections such as  Central-line associated bloodstream infections (CLABSI’s), nurses were especially interested in new technologies to reduce these potential deadly infections.

One of the technologies drawing considerable attention was SwabFlush, from Excelsior Medical (a Dowling & Dennis client). SwabFlush combines the SwabCap disinfection cap for needleless IV Connectors with a flush syringe. More information at www.swabflush.com.

Video of Tony Saia (VP of Global Marketing for Excelsior) demonstrating SwabFlush during INS:

Study Shows Promise of Disinfection Cap as Weapon in the War on Infections

For years, efforts to reduce central-line associated bloodstream infection (CLABSI) rates have focused on relatively complex initiatives – including “bundles” of evidence-based practices and technologies that together create multi-layered protection against infections. Now, the early results of a prospective, peer-reviewed clinical trial suggest that the use of a simple but ingeniously designed device can contribute to improved disinfection and allow for reduced CLABSIs.

That device – SwabCap® by Excelsior Medical – is also known as a disinfection cap. SwabCap supplements manual disinfection of IV connectors, long thought to be a weak point in CLABSI prevention because the method is subject to variation and noncompliance. The study results were recently reported at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).

Early results of the prospective, peer-reviewed clinical trial demonstrated that SwabCap® improved disinfection and allowed for reduced central-line associated bloodstream infection rates of more than 79%. Those improvements were seen in the four-hospital NorthShore University HealthSystem (Evanston, Ill.) after SwabCap was implemented for use on all central lines.

Notably, the gains were made even though the hospitals already had a low rate CLABSI rate of 1.95 per 1,000 catheter days before SwabCap was tried.

NorthShore also studied the device’s effectiveness a second way: it compared the density of colony-forming units (CFUs) of bacteria in blood samples when SwabCap was used to CFUs in samples when it wasn’t. During the SwabCap phase of the research, contaminated samples were 75% less dense with bacteria.

The new data is the most extensive ever gathered on SwabCap. The device is in use at multiple institutions, sometimes allowing for a drop in infection rates that is even more dramatic than at NorthShore. More at http://www.swabcap.com.