WASHINGTON, DC—A new CDC study reports an 18% national decrease in central line-associated bloodstream infections during the first six months of 2009, compared to the previous three years.

The report is based on data from CDC’s National Healthcare Safety Network (NHSN) and is the first to show state-specific healthcare-associated infections data from the 17 states required to report their central line-associated bloodstream infections to CDC.

The report will serve as the baseline from which states can assess their own progress towards eliminating these infections.  “To put it as simply as possible, this report gives us a snapshot of where the country stands in our efforts to prevent central line-associated bloodstream infections,” said Arjun Srinivasan, MD, associate director for Healthcare-Associated Infection Prevention Programs in CDC’s Division of Healthcare Quality Promotion.

Healthcare-associated infections (HAIs) are a significant burden in the United States, associated with approximately 99,000 deaths and costing up to $30 billion each year, according to CDC. Bloodstream infections occur when bacteria enter a patient’s bloodstream, either from their skin or from the environment surrounding them.   Studies have shown that the use of a central line is an important risk factor for a bloodstream infection, but that these infections are preventable.

In total for the 17 states, 4,615 central line-associated infections were reported to CDC. This is an estimated 18% fewer infections than were predicted. Srinivasan said that the reduction “reflects the work of facilities; local, state and federal government; and cross-cutting partnership groups.”

Reporting Central-Line Associated Bloodstream Infections

The report indicated that 11 states experienced a reduction in central line-associated bloodstream infections—Vermont, Colorado, Delaware, Massachusetts, New Hampshire, New Jersey, Oklahoma, Oregon, Pennsylvania, Virginia, and Washington. Maryland and Tennessee were the only states that had higher infection ratios than expected.

Officials noted that the overall decrease cited in the report is a step forward in meeting the HHS prevention goals of a 50% five-year reduction in central line-associated bloodstream infections. “The real test will be comparing the data - the data in future reports which will be published every six months.  At that point we can judge progress over time and determine whether or not central line-associated bloodstream infection prevention efforts are driving infections down,” said Srinivasan.

Currently only 17 states are required to report HAIs to CDC. “Not all states require the use of [CDC’s] national healthcare safety network, but certainly there is an increasing trend and we expect that trend will continue to encourage public reporting at the state level,” said HHS official Don Wright, MD.

Wright said that all 50 states have submitted state plans to reduce HAIs to HHS. HHS is also drafting strategies to improve infection control practices and reduce healthcare associated infections in ambulatory surgical centers and in dialysis centers.  

Reducing Infections

Peter Pronovost, MD, a professor at Johns Hopkins University, emphasized that bloodstream infections are preventable. His team implemented checklists that included simple steps such as requiring doctors to wash their hands. The checklist was credited in helping to nearly eliminate these infections from over 100 Michigan intensive care units.

Pronovost said that Johns Hopkins, along with AHRQ, the American Hospital Association and the Michigan Health and Hospital Association, is seeking to implement the program used in Michigan across the US. The program is called “On the CUSP: Stop Bloodstream Infections.”

So far he said that 33 states have committed to participate in over 600 hospitals. “All of the hospitals in Rhode Island, 94 percent in Hawaii, and approximately half of New Jersey and Georgia have virtually replicated these Michigan results.”

According to HHS, four categories of infections account for approximately three quarters of HAIs in the acute care hospital setting: 1) Surgical site infections; 2) Central line-associated bloodstream infections; 3) Ventilator-associated pneumonia, and; 4) Catheter-associated urinary tract infections. Infections associated with Clostridium difficile and MRSA also contribute significantly to the overall problem. The frequency of HAIs varies by location. Currently, urinary tract infections comprise the highest percentage (34%) of HAIs followed by surgical site infections (17%), bloodstream infections (14%), and pneumonia (13%)

The American Recovery and Reinvestment Act of 2009 includes $50 million authorized to support states in the prevention and reduction of HAIs. The HAI Recovery Act funds will be invested in efforts that support surveillance and prevention of HAIs, encourage collaboration, train the workforce in HAI prevention, and measure outcomes.

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