UPMC St. Margaret used to use alcohol caps for central lines, and with those had a very low infection rates. The use of the caps was discontinued and a disturbing trend emerged.
“When that happened we saw almost a double of our infection rates,” said Jenny Bender, infection preventionist, now at UPMC Presbyterian, formerly with St. Margaret, “they still weren’t awful but they were way higher than what we were used to seeing, which was zero.”
The challenge became keeping bacteria from entering the bloodstream through a central line, a catheter which is placed in a large vein to deliver medicine and fluids during hospitalization. For patients in intensive care units, central lines can be accessed more than 20 times per day. In order to bring infections back down, nurses were reminded of and re-trained on some basics.
“Things like scrubbing the hub of the IV before you access it with any kind of syringe,” said Bender, “things like proper labeling of your tubing, dressing and bags of medication and making sure those tubes and dressings were being changed according to the best practice technique and at the right times of day.”
Bender said this doesn’t mean nursing care was lacking, rather some may have simply started to rely too heavily on the effectiveness of alcohol caps.
“Those alcohol caps work on their own without any best practices in place and although, per policy, we never are supposed to change our nursing practice,” she said. “I think when you have something like that it can mask any issues you might have so when they were taken away we started to see more infections than we had before because maybe we had gotten a little bit lax in our practice.”
Three hospitals were part of a small study on reducing bloodline infections. Two of them, Texas Health Presbyterian Hospital of Dallas and Loyola University Medical Center in Maywood, Illinois, used disinfection caps, the third, UMPC St. Margaret in Pittsburgh showed it is possible to reduce infections even with limited resources.
“This little study that we did kind of proves that you can get back to zero and really fight infections even if you don’t have all the little gadgets that are out there for you to use, sometimes those are expensive,” said Bender, “even if you just have the bare minimum you can still focus and do education on good nursing care and still get your infections back down to zero.”
Going back to the basics can net the biggest benefit, according to Bender. She said other basic steps of maintaining a safe central line include washing hands before accessing the line, conduct line flushing; and determine if the line is still needed – if it’s not, then obtaining an order to have it removed.
The findings are being presented at the annual conference of the Association for Professionals in Infection Control and Epidemiology in Anaheim, CA this week.
