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”

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.

IV Needleless Connectors and Infection Risk

It’s an inevitable part of medicine that changes in technology have unintended consequences — and that not all of them are favorable consequences.

One example is the implementation of needleless connectors for IV catheters. Designed to protect healthcare workers against accidental needlesticks, these IV connectors are used hundreds of millions of times in the US every year.

However, the same connectors are also proving to be a source of potentially dangerous central line associated bloodstream infections (CLABSIs).

Gregory Schears, M.D., a widely published critical care specialist and the physician liaison to the PICC team at the Mayo Clinic in Rochester, Minn., spoke on this topic at a meeting earlier this summer sponsored by the Joint Commission.

The prestigious and influential Joint Commission, which is the primary accreditor of healthcare facilities in the US, built its annual conference around the theme of “Come Together: A Gathering of Leading Ideas in Quality and Safety.” Dr. Schears’ talk was titled “Needleless Connectors: Where Did We Go Wrong and How Do We Make It Right?”

He began his talk by tracing the history of needles and needle-safety technology in medicine. While needleless IV connectors are very effective at protecting healthcare workers, he said, they introduce new levels of risk to patients.

“We have gone into a series of unintended consequences where what was right for the healthcare worker now may be harmful to the patient,” he said. Safety technology has largely solved the problem of accidental needlesticks during the delivery of infusion therapy, but he added: “Our responses with needleless connectors have jeopardized patient care because of the increasing risk of infection.”

How to solve this dilemma?

Dr. Schears and others are investigating the possibility that passive technologies — such as an inexpensive, twist-on disinfection cap to protect and disinfect needleless connectors between line accesses — might be part of the solution.

“We probably need to look to passive technologies such as this to help us out,” he said. His research is exploring “the question of what we can do, to help reduce colonization and subsequent infections that are associated with needleless connectors.”

Dr. Schears will be speaking about his research, at the upcoming annual conference of the Association for Vascular Access in early October. He describes his research in a brief video on disinfection caps, which you can view as part of this blog.

CMS Gets Tough on Infection Reporting

Ushering in the new year in its own way, the Centers for Medicare and Medicaid Services (CMS) has dropped a hammer on hospitals. A new rule requiring hospitals to report certain central line-associated bloodstream infections (CLABSIs) went into effect last month.

Specifically, the rule states that hospitals must now report the number and rate of adult patients in their intensive care units who get CLABSIs — or the hospitals’ Medicare payments will be reduced by two percent.

We first wrote about this rule in our October 27, 2010 post and you can read the rule’s details there. Part of the rule requires the infection data to be publicly reported on the government’s website, That part of the rule will go into effect later this year.

At Dowling & Dennis, we applaud CMS’ report-or-pay approach. In fact, we think they should carry it a little farther. For instance, the rule only concerns patients in ICUs. We think it should apply hospitalwide.

Even at this point, though, we think this national incentive will be a useful supplement to the patchwork of state reporting laws. There are 27 states that make infection reporting mandatory, with two more that require confidential reporting, and three that have voluntary reporting systems. We expect that the CMS rule will push most hospitals across the country to divulge their infection data.

After all, two percent of Medicare payments is real money.

We’ve learned how important the CLABSI issue is because several of our current or former clients — including Excelsior Medical (SwabCap), Johnson & Johnson (Biopatch), RyMed Technologies (InVision-Plus), and Venetec International (StatLock) – produce medical devices shown to reduce CLABSI risk. Much of our effort the past several years has been to promote the use of these safer technologies.

Where these devices have been implemented, CLABSIs have generally gone down – dramatically. CLABSIs still kill 31,000 U.S. patients per year – in part, because hospitals aren’t adopting such devices fast enough, as many infection control experts have testified.

The CMS rule has several things going for it. For one thing, the data that hospitals report to HospitalCompare will be based on objective, CDC-defined criteria. That isn’t always the case with some state reporting requirements, so that when a consumer compares Hospital A’s infection rate to Hospital B’s, they’re actually comparing apples to oranges. The CMS rule should get us close to apples-to-apples comparisons.

Also, many consumers who have to be hospitalized are likely to go to HospitalCompare to find the safest facilities. You would think all institutions will want a presence in that online system – a presence that includes a low CLABSI rate. This is CMS’s hope, and ours.

New CMS Rule on Infection Reporting

If hospitals see more revenue from the Centers for Medicare and Medicaid Services (CMS) next year, they may owe a thank-you to the Society for Healthcare Epidemiology of America (SHEA) – and their own infection prevention pros.

SHEA is urging infection control professionals to get up to speed on new CMS requirements for reporting central line-associated bloodstream infections (CLABSIs). Starting in 2011, CLABSIs and certain other healthcare-acquired infections (HAIs) will have to be reported on the CDC’s National Healthcare Safety Network (NHSN) for hospitals participating in the CMS Hospital Inpatient Quality Reporting Program. Participation in the programs is voluntary but here’s the catch: Hospitals can’t get full CMS payment without taking part.

How does the process work? Hospitals report their CLABSI data from their adult and pediatric intensive care units and neonatal intensive care units to NHSN, which then shares it with CMS.

Each facility’s data will be also be uploaded to CMS’s Hospital Compare tool, which is designed to publicly report hospital performance so it can be usefully compared.

The focus on CLABSI data will benefit patients will also live in the value of industry’s contributions to preventing infections. Included in the latter, among companies with which we work, are Excelsior Medical and RyMed.

The partnership between CMS and NHSN is intended to create greater transparency of HAI data, make hospitals more accountable for quality care, and boost facility’s support for infection prevention programs and professionals. Read more about NHSN here: .