Keeping it clean, safe for patients

A Sacramento-area hospital is emerging as a nationwide leader in the push to eliminate deadly infections picked up by unsuspecting hospital patients.

Sutter Roseville Medical Center has overhauled the way it uses catheters inserted into patients' veins. The thin tubes are a common entryway for potentially toxic bacteria.

The hospital has not had a single bloodstream infection among more than 3,000 of these patients for the past two years, as a result of the changes, said Sophie Harnage, the nurse who manages the hospital's infusion unit and developed the new system.

Harnage's work, among similar efforts at hospitals around the country, is being applauded by national infection control advocates.

"These interventions have shown you can get to zero," said Dr. William Jarvis, a noted infection control expert who spent 23 years at the federal Centers for Disease Control and Prevention. "We should no longer believe the fallacy that bloodstream infections are going to happen."

An estimated 2 million health care-associated infections and 90,000 deaths occur every year in health care facilities in the United States, according to CDC figures. An unwashed hand, a contaminated instrument, or residual germs at the site of a patient's incision. All these can lead to severe illness or death – and higher costs for patients, insurance companies and hospitals.

Hospitals like Sutter Roseville have more at stake than sicker patients and potential wrongful-death lawsuits.

Starting in October, the Centers for Medicare and Medicaid Services will no longer pay hospitals for the costly treatment of complications from hospital- acquired infections, including those in patients with catheters. At up to $40,000 per infection, the unreimbursed costs could pile up.

Many states, including California, are trying to force hospitals to make their infection rates public. And a new bill by Sen. Elaine Alquist, D-Santa Clara, will require California hospitals and nursing homes to screen high-risk patients for the "superbug" – methicillin-resistant Staphylococcus aureus, or MRSA – and to follow federally recommended infection control guidelines.

"Everybody is scared to death about this," said Kathleen McHugh, CEO of the Association for Vascular Access, which recently published Harnage's paper about her work at Sutter. "It is going to force people to deal with a problem that is increasingly serious and has exponentially grown over the past two decades."

Tackling the rise in hospital- acquired infections has taken on new urgency with the advent of MRSA, bacteria that are resistant to many common antibiotics.

Added to that are sicker patients with more complicated medical needs, said Jarvis.

"We have some of the best infection control systems in the world, but also within the last two decades, we have had an increase in the severity of illness in patients," he said. "We have more patients with compromised immune systems, more invasive devices and surgical procedures."

About 90 percent of bloodstream infections in hospitals occur in patients who have catheters – which are used to deliver fluids such as medications or nutritional supplements, to drain urine from the bladder or to introduce instruments for surgery.

Sutter Roseville's new protocol specifically targets catheters inserted into a vein in the arm, groin, neck or under the collarbone, then threaded into the vena cava, which carries blood into the heart. These catheterizations are called "central lines." They're commonly used for patients in intensive care units, for chemotherapy or for intravenous nutrition.

In 2005, Sutter Roseville Medical Center reported 11 bloodstream infections in patients with central lines. Harnage set out to find ways to reduce infections in the most common type of central line – those inserted into a vein in the patient's arm. They're the only type of central line that can be inserted by specially trained nurses as well as doctors.

Harnage studied research on ways to prevent central line infections – from proper hand-cleaning to reducing insertion mistakes.

And now Sutter Roseville almost exclusively uses central lines in patients' arms.

The approach pleases most Sutter doctors because it reduces complication rates, said Dr. Randy Martin, an infectious disease specialist at Sutter.

Harnage developed her own "bundle" of practices and established a nursing team to carry out the procedures.

Last week, 77-year-old Betty Crawford was the recipient of a catheter for medications she needs to treat a urinary tract infection. As Crawford lay awake and chatty in the hospital bed, covered in a big, blue sterile sheet, nurses Clare King and Ruthanne Fray went to work.

Wearing full surgical garb, including gown, hat and gloves, they worked from a cart pre-loaded with the instruments, germ-killing antiseptics and other tools needed for the catheterization.

"This is not rocket science," Harnage said. "It's practice, consistency, the reliability and focus of a specially trained team that responds day after day."

Harnage's work has interested hospital administrators and nursing managers around the country, said McHugh.

"I get calls every single day from people who want to know how to do this," she said.

Harnage hopes her work can help other hospitals develop their own infection control "bundles," starting with other area Sutter hospitals.

"All patients deserve to come into a hospital and be free from infection," she said. "If it is performed reliably on each and every insertion, I believe you will eliminate these infections."

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