Infection Control Liaison, MedFlight
The cost of healthcare acquired infections is great. A Boeing 747 crash once a week for an entire year is equal to the number of people dying from a healthcare acquired infection (HAI). The latest statistics show approximately 23,000 people die each year due to an infection, such as pneumonia, bloodstream infection or a urinary tract infection contracted while receiving healthcare. Adding healthcare costs, lost wages, legal costs and other patient factors the annual cost of an HAI is between $96 to $147 billion.
Three of the most common HAIs are ventilator associated pneumonia (VAP), catheter related bloodstream infection (CRBSI) and catheter related urinary tract infection (CAUTI).
A VAP is defined as a pneumonia that develops 48 to 72 hours after intubation. Chart reviews estimate VAP as being the cause of 50% of all hospital acquired pneumonia, occurring in up to 27% of ventilated patients. Mortality rates vary ranging from 33% to 50%. A 2017 meta-analysis showed the average cost of an ICU stay was $19,000, compared to $80,000 for an ICU patient with a VAP. Bacteria begin to form biofilms on the ET tube within hours of insertion. The type of bacteria most frequently causing VAPs include Staphylococcus, Enterococcus, Enterobacteriaceae, Pseudomonas and Acinetobacter. Bacteria migrates from the oral cavity to the stomach then to the esophagus and is aspirated into the lungs.
Costs for a CRBSI range between $17,896 to $48,108 with an increased 10 days length of stay. A CRBSI increased mortality rates to 150 deaths per 1000 central line patients. In 2017 there were an estimated 119,247 CRBSI due to Staphylococcus aureus with an associated 19,832 deaths. Staphylococcus, including MRSA, is the number one bacteria causing CRBSIs followed closely by Pseudomonas, Enterococci, Klebsiella and Acinetobacter. Infections are due to bacteria migrating down the IV catheter or central line, contamination of the catheter at insertion or contamination of the IV tubing ports. All may lead to the formation of biofilm on the catheter. Intraosseous devices cause bloodstream infections approximately 0.6%. IO infections are typically due to prolonged use.
Another common cause of HAIs is urinary catheters. The incidence of CAUTIs in the US is approximately 4.40 per every 1000 urinary catheter days. The cost of a CAUTI ranges from $800 to $10,197 depending on location of the patient, increased length of stay and comorbidities and complications such as sepsis due to the CAUTI. Gram negative bacteria – E. coli, Pseudomonas, Klebsiella along with Candida species were the most common pathogenic causes.
What you can do to protect your patients:
- Hand hygiene with frequent glove changes. Remember to change gloves between tasks and between patients
- Elevate the head of the bed at least 30o for ventilated patients if not contraindicated by:
- Spinal fracture or injury
- Open abdomen
- Perform subglottal suctioning when adjusting the tube or balloon
- Insertion of an IV or IO is a sterile procedure – you are introducing a sterile product (IV/IO cath) into a sterile site.
- Make sure to prep the site as thoroughly as possible
- Do not use tape that’s been in your pockets or thrown in a bag. Tape is easily contaminated with bacteria
- Scrub the hub – don’t just do a promissory swipe with an alcohol pad. Use friction for at least 10 to 15 seconds
- Keep the urinary catheter bag below the level of the bladder. This may take some creativity – at the very least do not place the collection bag on the abdomen or carry it above the cot
- Do not “break” the system – do not separate the catheter from the collection bag
- Empty aseptically – clean the spigot with and alcohol wipe; do not touch the spigot to the container
These are simple, easy to accomplish methods to protect your patients from a healthcare associated infection.