Medical teams - not individuals - are critical to the prevention of catheter-related bloodstream infections, as well as for the overall health, safety, and welfare of patients, according to an editorial by two Virginia Commonwealth University physicians published in today's issue of the New England Journal of Medicine.
Intensive care unit professionals use a number of devices and catheters to deliver intravenous fluids and medications to patients. There is risk of bloodstream infection anytime a worker handles a catheter, and the key organisms linked to these infections are commonly found on the patients' skin, or sometimes on healthcare workers' hands.
In the United States, an estimated 50,000 bloodstream infections occur in ICUs each year related to central catheters, with approximately half these cases resulting in patient death.
"When it comes to patient safety, we need teams of healthcare workers to foster excellent care," said Richard P. Wenzel, M.D., professor and chair in the Department of Internal Medicine in the VCU School of Medicine and president of the International Society for Infectious Diseases, the largest professional organization related to infectious disease. "Today any breech in technique is not acceptable, and we now have zero tolerance. The team itself creates a social pressure of excellence for patient safety."
In an editorial commenting on a recent study published in the New England Journal of Medicine, Wenzel, together with Michael B. Edmond, M.D., acting chair in the Division of Infectious Diseases, emphasized the value of medical teams in the prevention of catheter-related bloodstream infections. The study, by a research team from the Johns Hopkins University School of Medicine, showed that teams of physicians and nurses in Michigan hospitals reduced the rates of infection by almost 70 percent.
"The work of Dr. P. Pronovost and colleagues is the most important paper published in infection control in the last decade because it demonstrates that careful attention to good practices results in a dramatic reduction in bloodstream infections," said Edmond.
Wenzel said that in the past, colleagues in ICUs would avert their eyes from healthcare workers who failed to wash their hands, or had a small tear in their glove, and would continue with the procedure rather than restarting it.
"There have been significant improvements to patient safety, and patients are safer in hospitals today, compared to 10 years ago," Wenzel said. "It is reasonable for patients to take charge of their care to some extent. I tell my patients not to allow anyone to touch them or any catheter unless they first see them wash their hands and put gloves on," he said.
Wenzel said that to prevent infection, it is imperative for the healthcare team to engage in the basic techniques of hand-washing, to follow strict protocols and to use the catheters for only as long as necessary.