In the world of infection prevention, creative solutions to new challenges are key. A notable example of this principle in action is the groundbreaking work done by a team of infection preventionists at Tampa General Hospital (TGH). They successfully repurposed an existing intervention to halt bloodstream infections (BSIs) in their tracks for patients undergoing extracorporeal membrane oxygenation (ECMO) in the cardiothoracic intensive care unit (CTICU).
Despite the critical role of ECMO treatment in managing severe heart and lung conditions, there has been a significant gap in the literature on infection control related to ECMO. Acknowledging that a clear set of standardized infection prevention protocols for ECMO was absent, the professionals at TGH focused on adapting their knowledge and experience in surveillance and central line-associated bloodstream infection (CLABSI) prevention to develop a fresh set of protocols for their CTICU team.
A concerning prevalence of BSIs among gravely sick patients receiving ECMO treatments in TGH’s 18-bed CTICU spurred the team into action. Peak BSI rates were recorded when the CTICU was inundated with critically ill COVID-19 patients requiring ECMO treatment transferred from neighboring hospitals.
The TGH team formed a multidisciplinary task force that identified a deficiency in standardized procedures for infection prevention, particularly in the maintenance of cannula sites, as well to address the environmental issues contributing to the surge in BSI rates.
To tackle this challenge, the team added specific components to their standard CLABSI prevention methodology, including a targeted care bundle for ECMO-specific cannula sites. This novel approach involves a meticulous and systematic deployment of antimicrobial dressings, aseptic techniques, secure cannula fixation, daily antimicrobial patient bathing, and careful management of environmental factors including ensuring cannulas weren’t allowed to touch the floor.
Strict compliance was promoted through weekly infection prevention rounds and an audit tool to track adherence to the newly-implemented bundle protocols. The results were striking—BSIs in ECMO patients admitted to the CTICU decreased drastically from 36% in October 2021 to a remarkable 0% by June 2022. Notably, this decline was sustained over a seven-month period. Details of the study were presented at the annual conference held by the Association for Professionals in Infection Control and Epidemiology (APIC).
APIC President, Tania Bubb, lauded the TGH team for their impressive achievement in not only recognizing the infection challenges with ECMO but also for developing an innovative and transferable set of protocols for other institutions to replicate. This immense success story serves as a beacon of hope for hospitals everywhere looking to improve patient outcomes through proactive infection prevention.