March 1, 2011
Fewer Patients in I.C.U. Getting Blood Infections
By DENISE GRADY

Bloodstream infections caused by tubes inserted into major blood vessels of intensive care patients showed a big drop from 2001 to 2009, government researchers said on Tuesday.

But the researchers also reported unacceptably high rates of the same type of infections in other hospital wards and in people receiving dialysis for kidney failure.

The illnesses, called central-line infections, can be serious, with death rates of 12 percent to 25 percent. Central lines are tubes that are usually placed in the large veins of the neck or chest to deliver medicines and nutrition.

Infections in these lines are common, but also largely preventable. Bacteria like staphylococcus can be warded off with simple measures like washing hands, wearing sterile gowns and drapes, and following the proper techniques for inserting and maintaining the lines.

The estimated number of central-line infections in intensive care units fell to 18,000 in 2009 from 43,000 in 2001, a 58 percent drop, according to a report published online Tuesday by the Centers for Disease Control and Prevention. Experts attributed much of the progress to campaigns aimed at improving techniques for managing the lines in intensive care units, where they are most commonly used.

The figures mean that in 2009, such measures prevented 3,000 to 6,000 deaths and saved $414 million. Assuming the decrease in central-line infections was steady from 2001 to 2009, as many as 27,000 lives might have been saved at a cost savings of $1.8 billion.

The numbers are rough estimates. The 2001 figure of 43,000 infections, for instance, could have been as low as 27,000 and as high as 67,000.

Even so, Dr. Thomas R. Frieden, director of the C.D.C., called the drop in infections in intensive care units “very substantial progress.” But, he said in a telephone news briefing, the infections still occurred far too often, affecting 80,000 patients a year and killing at least 10,000 of them.

About 350,000 patients a day receive dialysis in the United States. In 2008, about 37,000 of them suffered central-line infections, Dr. Frieden said, adding that the infections are the leading cause of hospital stays and death in people on dialysis.

He said the issue was especially important because the number of people on dialysis is expected to double in the next decade because of increased rates of kidney failure linked to diabetes and the aging of the population.

One way to cut down on infections in people with kidney failure is to avoid using a central line for dialysis. It is preferable for such patients to have an operation that connects an artery and a vein, forming a structure known as a fistula that can be used for dialysis.

Fistulas have about one-sixth the risk of infection as a central line. Needles are inserted into the fistula for each treatment and removed when the treatment is done, unlike central lines, which stay in the blood vessel and emerge through the skin, posing a constant risk of infection.

Despite the widespread recognition that fistulas are safer, about 80 percent of dialysis patients in the United States start treatment with a central line. Because the surgery to create a fistula must be completed six weeks or more before dialysis starts, doctors must anticipate kidney failure and perform the procedure well ahead of time.

Dr. Arjun Srinivasan, a medical epidemiologist at the C.D.C. and one of the authors of the new report, said that hospital wards outside of intensive care units needed to adopt hygiene techniques for inserting central lines.

Some hospitals have already made those improvements. Dr. Neil Fishman, an infectious disease specialist and the director of health care epidemiology and infection prevention at the University of Pennsylvania Health System, said that at the Hospital of the University of Pennsylvania, practices first put into place in intensive care were extended to other wards.

In 2005, there were 40 to 50 central-line bloodstream infections at the hospital every month, Dr. Fishman said. “That was our peak,” he said. “In 2011, we have zero to two every month. That took a lot of work from a lot of people, and a lot of dedication.”

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