University of Vermont

College of Medicine

Vermont Medicine Magazine

Allen’s Study Focuses on Eradicating Central Line-Associated Bloodstream Infections

Gilman Allen, M.D., Assistant Professor of Medicine
Gilman Allen, M.D., Assistant Professor of Medicine

Even in 2014, one of the best practices hospitals can encourage in their medical and surgical intensive care units may be proper hand washing.

In a study published in the May issue of the American Journal of Infection Control, a team of University of Vermont researchers led by Gilman Allen, M.D., assistant professor of medicine, strategized the reduction of central line–associated bloodstream infections (CLABSI), which are responsible for some 28,000 potential annual deaths and a cost of up to $2.3 billion annually in the United States alone. Indeed, infections had long been considered a natural consequence of central line use, in part because they lines are frequently placed for an extended period. Treatment with antibiotics is standard, but there’s also a significant risk of bloodstream infection, sepsis, and organ failure.

What began as a Fletcher Allen Health Care quality improvement initiative to track CLABSI rates soon grew to include both the medical and surgical intensive care units (MICU/SICU), along with the UVM/Fletcher Allen Clinical Simulation Lab. Because medical residents are responsible for the bulk of MICU central line placements, they received training alongside anesthesiologists and critical care physicians and surgeons, many of whom hadn’t received such instruction in a decade or more.

Standardized best practices for the insertions were established and included use of a procedure cart with all related equipment to minimize the skipping of steps. The importance of electronically documenting insertions, which was happening only 48 percent of the time, was underscored, since doing so would theoretically lead to better care and earlier removal. Finally, vascular access nurses provided instruction in proper hand washing, the use of chlorhexidine to clean each patient’s skin, gloving and gowning, and the maintenance of a sterile field.

The results: compliance with skin prep and electronic record-keeping rocketed to 100 percent, and infection rates – admittedly not high to begin with – dropped so low that when there was a lone infection in the MICU over the course of three years, says Allen, everyone in the department felt some level of responsibility. In addition, nurses are fully empowered to halt a procedure if they observe a breach in protocol, which Allen calls a “drastic change in culture.”

Study collaborator Cate Nicholas, M.S., P.A., Ed.D., the simulation lab’s director of education and operations, notes, “This is a perfect way to go about process improvement. It’s getting all hands on board, getting the quality team, nurses, physicians, and simulation all sitting around the table.”

The research team intends to apply the lessons of CLABSI – that “diligent attention to every little detail,” says Allen, “can knock this beast down” – to the challenges of super bacterial infections like MRSA (Methicillin-resistant Staphylococcus aureus) and C. difficile diarrhea.