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Tom Smart, Deseret News
The burn center at University Hospital recently celebrated two years with no central line infections in its burn and trauma ICU. Nurse and quality manager Lois Remington displays IVs that have helped stop central line infections Monday, Sept. 21, 2015, in Salt Lake City.

SALT LAKE CITY — At the burn center at University Hospital, zero is a good thing.

The center recently celebrated two years of zero: 48 months of no central line infections in its burn and trauma ICU — a nearly unheard-of feat in the medical world.

"I never thought we'd make it to year one," said Lois Remington, the quality manager at the center who designed and implemented new guidelines. "That's how unheard of it is."

Central line-associated bloodstream infections, also called CLABSIs, are a type of hospital-acquired infection that happens when germs get through the central catheter — a tube that doctors place in a vein in the patient's neck or chest — and into the bloodstream.

They "result in thousands of deaths each year and billions of dollars in added costs to the U.S. health care system, yet these infections are preventable," according to John Jernigan, the director of the Office of Prevention Research and Evaluation at the Centers for Disease Control and Prevention.

In a statement, he applauded the U. burn center "for reaching this important milestone.”

Over the past five to 10 years, health care providers have increasingly turned their attention to reducing the incidence of preventable health care-associated infections, said Remington.

For decades, the practice of changing IVs every 48 hours went virtually unchallenged.

"At that point, we thought it kept the lines cleaner," Remington said. "The whole culture has changed."

But the high incidence of infections acquired from urinary catheters and central catheters prompted health officials to find a way to reduce these infections.

About 250,000 such infections occur in the U.S. each year. According to the Centers for Disease Control and Prevention, up to 1 in 4 patients who gets a central line infection dies.

And the cost of these bloodstream infections varies from $3,700 to $39,000 per episode, according to a study.

In Utah, where hospitals tend to do better than the national average in terms of health care-acquired infections, the health department recorded 86 central line bloodstream infections last year.

Because central catheters make it easier for nurses to get medication and fluid into the patient, there's long been an incentive to keep them in.

It's even harder to prevent infections in burn centers, Remington said. At the U. burn trauma ICU, which admits about 350 people a year, patients often have exposed, open wounds and need to undergo multiple surgeries. Some have to stay up to five months in the hospital.

"It's just not a clean environment," Remington said.

But Remington said the burn center's success stemmed from a systemic intervention that focused on changing the culture of IV use by implementing multiple changes at the same time — what Remington calls a "bundle."

The U. burn center "bundle" meant switching to IV caps that are disinfected with alcohol, standardizing and strictly enforcing procedures for inserting and removing the catheters, and conducting daily meetings between all the staff responsible for a patient to determine whether the catheter should remain in.

"Every day, every patient, every time we conference in this room, (we ask), 'Do we need a line in this patient?'" said nurse manager Brad Wiggins.

From April of 2011 to October of 2013 — when the team implemented the new standards — the center had 11 central line infections.

In the two years since then, they've had zero.

The center will be featured in a forthcoming research paper that will be published in JAMA Surgery, due by the end of the year, outlining the program's success.

"There's no other ICU I know of that takes care of such sick patients that has done this," Remington said.

Nurse Kassie Ziebarth said the center has been troubleshooting how to prevent infection for years. She said old methods, such as changing dressing at different intervals and instituting checklists without a strong systematic approach, had shown only small improvement.

"It's been such a battle," said Ziebarth. She said the nurses sometimes felt hopeless because their patients often need aggressive treatment that can only be delivered through a central catheter.

That's what makes the discovery of a method that finally works so much sweeter, Ziebarth said: "It's like the Shangri-La of discoveries."

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