Interview: Inside the Problem of Hospital-Acquired Infections

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The hospital ought to be a safe place. After all you only go there when you are vulnerable and need help. It should not be the place where you develop an infection due to the sanitary conditions that exist, yet, this happens all too often in both Canada and the United States.

Why is this the case? Earlier this year I started to take a closer look at what was happening in our hospitals.

In April, as a result of my preliminary research, I posted an article on Steno. Steno infections are rarer than MRSA and C.diff infections and are exclusively hospital-acquired. This means that the safe haven was the source. This is not an acceptable situation.

The following email interview with Dr. Chuck McIntosh, Vice President and Chief Medical Science & Technology Officer at Cook Group, came about as a result of that article.


1) What are hospital-acquired infections (HAIs)?

Hospital-acquired infections (HAIs) are infections that are acquired as secondary conditions during a patient’s stay at a healthcare facility; it is important to note these infections are unrelated to a patient’s primary condition.

HAIs are among the most common adverse events in health care, with the Centers for Disease Control and Prevention (CDC) estimating that there are approximately 1.7 million HAIs acquired and 99,000 associated deaths in hospitals each year in the U.S. alone.

2) What are catheter-related bloodstream infections (CRBSIs)?

Catheter-related bloodstream infections (CRBSIs) or central line bloodstream infections develop when bacteria enters a patient’s bloodstream through the channel created by a central venous catheter (CVC) which then colonize the surface of the catheter.

It is one of the most preventable infections, which can ultimately lead to acute respiratory-distress syndrome, kidney failure, shock and death. These infections are also very expensive to treat, with treatment costs of upwards of $30,000 per patient.

3) How prevalent are they in hospital settings?

Of the 1.7 million HAIs in the U.S. each year, about 250,000 are CRBSIs. They are the second leading cause of death associated with HAIs, second only to pneumonia.

According to research conducted by Johns Hopkins Medical Institutes, as many as 28,000 patients die each year in the U.S. because of CRBSIs, and that’s tragic because we have a technology that could almost entirely eliminate them if used universally.

4) What do we know about them?

CRBSIs are largely viewed as a preventable condition as there have been studies proving that through use of the best technology bundled with hygiene processes they can be nearly eliminated.

The CDC has called for healthcare workers to wash their hands before and after contact with each patient, change gloves when moving from a contaminated site to a clean site on the same patient and use full barrier sterile precautions when inserting CVCs.

These barriers include wearing a cap, mask, sterile gown, sterile gloves and a large area drape that extends well beyond the working field. Additionally, chlorhexidine is preferred over betadine prep as it has shown to be more effective in reducing infections.

Chlorhexidine discs for dressing of CVCs also have been demonstrated to reduce infections and to be cost effective.

5) What steps are companies taking to improve patient care?

In the past decade, there have been great advances in the medical device industry that have proven extremely effective in the battle against CRBSIs. Of course, these devices must be used hand-in-hand with strict hygiene precautions and procedures.

One example is CVC-related technology that has moved from simple, non-coated CVCs to a new generation of more advanced catheters impregnated with antibiotics.

For example, Cook Medical produces Spectrum, a line of CVCs that are impregnated with minocycline and rifampin, two antibiotics that work synergistically to provide broad-spectrum activity against gram positive and gram negative organisms.

The antibiotic agents contained within the catheter material help to protect patients from colonization of bacterial organisms on the catheter that can then enter a patient’s bloodstream and create a CRBSI.

Recently, clinical evidence has rebutted a previously held belief from some medical researchers that these types of devices could promote antimicrobial resistance.