Hospital-acquired infections are significant contributors to medical complications and associated healthcare costs. An estimated 2 million patients contract nosocomial infections annually and account for 44,000 to 98,000 deaths.1-3 The resulting extended hospital stays and treatment for infection-related illnesses are estimated to add $17-$29 billion to healthcare costs each year.1,3

Since 1970, the National Nosocomial Infection Surveillance System (NNIS) of the Centers of Disease Control (CDC) has tracked the incidence of hospital-acquired infections.4 Publication of NNIS data has resulted in wider recognition of negative outcomes associated with nosocomial infections and has encouraged efforts to reduce infection rates. Based on data collected by the NNIS, the CDC issued two evidence-based guidelines designed to address sources of infectious contamination. Guidelines for Hand Hygiene in Health-Care Settings and Guidelines for the Prevention of Intravascular Catheter-Related Infections were published by the CDC in 2002 to educate healthcare providers about two known contributors to nosocomial infections.2,4 Additional efforts to improve patient health have reinforced the importance of following these guidelines. The National Patient Safety Goals issued by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) include the reduction of risk for healthcare-associated infections. The JCAHO recommends compliance with the CDC hand hygiene guidelines, along with tracking of infection-related adverse events.5

The Guidelines for the Prevention of Intravascular Catheter-Related Infections were published based on NNIS outcomes data demonstrating that catheter-related bloodstream infections pose a substantial risk to patient health within the hospital.4 Recommendations for catheter selection, placement and care, as well as a substantial emphasis on education, have influenced the manner in which vascular catheterization is implemented in hospital settings.

Catheter-related bloodstream infections
The CDC intravascular catheter-related guidelines include several recommendations for the placement and care of intravascular catheters, as briefly summarized in Table 1.

Importance of education
The first strategy listed in the catheter-related infection control guidelines identifies quality assurance and continuing education as critical components for successful implementation of any program to decrease infection rates. Emphasis should be placed on education programs that enable healthcare providers to provide, monitor and evaluate care while also incorporating advances in infection control and prevention. The need for awareness of new technology and the evolution of care based on documented improvements in clinical outcomes is vital as new products and evidence-based information become available. Examples of the need to educate and update procedures are addressed in the recommendation to use 2% chlorhexidine gluconate as the preferred method of skin antisepsis and the availability of antimicrobial/antiseptic-impregnated catheters, cuffs and dressings.4 Recommendations for the use of these materials are based on well-controlled clinical trials. In the case of skin antisepsis, the recommendation to use 2% chlorhexidine represents a change in procedure based on data demonstrating the superiority of this antiseptic over 10% povidone iodine or 70% alcohol in lowering bloodstream infections.6

Costs of care and clinical outcomes
Along with recognition of the need to continually update infection control procedures is the necessity to balance patient safety and cost effectiveness. This effort is not insignificant, as hospitals, patients and insurance providers struggle with annual increases in costs of care. Without further investigation, recommendations to update procedures, particularly when new materials are advocated, may appear to add to the costs of care. But these direct costs of education and materials should not overshadow indirect costs of infection-related morbidity and death. For example, the CDC guideline recommending designated, trained intravenous-therapy personnel (an IV team) is based on data demonstrating a reduction in complications and costs when specially trained personnel manage catheter care.4,7,8 At one hospital an evidence-based intervention program was undertaken in the intensive care unit to prevent catheter-associated bloodstream infections. Pre-intervention data demonstrated an infection rate of 4.9 cases per 1000 catheter-days, compared to a post-intervention rate of 2.1 cases per 1000 catheter-days. Cost savings due to the decrease in infection rate were significant.8 Considering the estimated costs of up to $56,000 per infection case, the adoption of new guidelines, procedures and materials with demonstrated efficacy in reducing infections may produce beneficial results in overall costs of care, in addition to substantially improving patient outcomes.4

Conclusion
The infection control guidelines published by the CDC include evidence-based recommendations that have been demonstrated to decrease infection rates, subsequently improving patient outcomes. Reduction of infection rates is known to decrease the total cost of patient care. Education of personnel who are responsible for infection control is critical to success, however, and requires ongoing assessment of new data and materials to provide continual renewal of procedures and constant re-evaluation of results. A commitment to education, evaluation and re-assessment creates an environment that promotes enhancement of patient care.