Tailored ECMO care bundle eliminated bloodstream infections at Florida hospital
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Key takeaways:
- After the intervention, BSIs in patients with ECMO decreased from a high of 36% in October 2021 to 0% in June 2022.
- The decrease was sustained for 7 months.
SAN ANTONIO — Infection preventionists repurposed an existing intervention that eliminated bloodstream infections completely among patients receiving extracorporeal membrane oxygenation in the cardiothoracic ICU.
“We recognized that there is a large gap in the literature regarding extracorporeal membrane oxygenation (ECMO) care in relation to bloodstream infections (BSIs),” Mini Radhakrishnan, BSN, RN, CIC, an infection preventionist at Tampa General Hospital (TGH), told Healio. “As there were no standardized procedures for ECMO infection prevention, we wanted to take what we knew about surveillance and [central line-associated bloodstream infection (CLABSI)] prevention and implement procedures that would work for the cardiothoracic ICU (CTICU) team.”
She added, “At TGH, patient safety and zero harm are our top priorities. With these principles in mind, we recognized an unusual prevalence of BSI that was threatening extremely ill patients receiving ECMO at TGH’s 18-bed CTICU.”
The researchers noted in a press release that when BSI rates were at their peak, their facility’s CTICU was filled with “critically ill COVID patients” from surrounding areas who needed ECMO treatment and were transferred from other hospitals.
A multidisciplinary task force at TGH identified a lack of standardized infection prevention procedures regarding the care of cannula sites — as well as environmental factors — that may have allowed the BSI rates to increase.
Radhakrishnan and colleagues reacted by adding certain elements to their standard CLABSI prevention practices to create an ECMO-specific cannula site care bundle. The bundle, they explained, focused on standardizing the use of antimicrobial dressings, aseptic techniques, cannula securement, daily antimicrobial patient bathing and environmental factors like making sure cannulas did not touch the floor. From there, the team conducted weekly infection prevention rounds on the unit and tracked adherence to the bundle with an audit tool.
Overall, they found that BSIs in the CTICU patients with ECMO decreased from a high of 36% in October 2021 to 0% in June 2022. According to the study data, which were presented at the Association for Professionals in Infection Control and Epidemiology (APIC) annual conference, the decrease was sustained for 7 months.
“I believe that all hospitals that provide ECMO care to their patients can develop a set of ECMO infection prevention protocols that can be replicated in their cardiothoracic units,” Radhakrishnan said.
She explained that hospitals can add elements to a pre-existing set of practices for the prevention of CLABSIs like they did to create an ECMO-specific cannula site care bundle.
“Because ECMO line-related infections aren’t specifically tracked through [National Healthcare Safety Network], it would be easy for infection prevention teams to overlook a potential problem," APIC president Tania Bubb, PhD, RN, CIC, FAPIC, said in a press release. “The TGH team is to be congratulated for not only identifying the infections in this population but also for proactively developing a set of ECMO infection prevention protocols that can be replicated by other institutions that utilize the procedure in their cardiothoracic units.”
References:
- To eliminate COVID-Era bloodstream infections in heart, lung patients, Tampa hospital had to innovate. [Press release made available to media but not published online].
- Radhakrishnan M, et al. Bundled approach to reduce bloodstream infections in patients requiring use of extracorporeal membrane oxygenation. Presented at: APIC 2024; June 3-5, 2024; San Antonio (hybrid).
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Radhakrishnan M, et al. Abstract QAPI 20. Presented at: APIC 2024; June 3-5, 2024; San Antonio (hybrid).
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