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Preventing Central Venous Catheter-Associated Primary Bloodstream Infections: Characteristics of Practices Among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study

Published online by Cambridge University Press:  02 January 2015

Barbara I. Braun ,
Stephen B. Kritchevsky ,
Edward S. Wong ,
Steve L. Solomon ,
Lynn Steele ,
Cheryl L. Richards ,
Bryan P. Simmons  and
Evaluation of Processes and Indicators in Infection Control (EPIC) Study Group
Barbara I. Braun*
Affiliation:
Division of Research, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois
Stephen B. Kritchevsky
Affiliation:
Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
Edward S. Wong
Affiliation:
Infectious Disease Section, McGuire Veterans Affairs Medical Center and, Medical College of Virginia, Richmond, Virginia
Steve L. Solomon
Affiliation:
Division of Healthcare Quality PromotionCenters for Disease Control and Prevention, Atlanta, Georgia
Lynn Steele
Affiliation:
Division of Healthcare Quality PromotionCenters for Disease Control and Prevention, Atlanta, Georgia
Cheryl L. Richards
Affiliation:
Division of Research, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois
Bryan P. Simmons
Affiliation:
Quality Management, Methodist Health Systems, Memphis, Tennessee
*
Division of Research, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Boulevard, Oakbrook Terrace, IL 60181
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Abstract

Objectives:

To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI.

Design:

This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected.

Setting:

Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites).

Participants:

Process information was obtained for 3,320 CVC insertions with an average of 58.2 (± 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information.

Results:

Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs.

Conclusions:

Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 926 - 935
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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Footnotes

*

Society for Healthcare Epidemiology of America (SHEA) member epidemiologists and liaisons from hospitals participating in the EPIC process assessment component included Diane Baranowsky, RN; Sue Barnett; Sandi Baus, RN, CIC, MBA; Jacqueline Berry, RN; Terri Bethea, BSN; Gregory Bond, MSN, RN, CIC; Barbara Bor, RN; Diann Boyette, RN; Jacqueline P. Butler, CIC, MLT (ASCP); Ruth Carrico, PhD, RN, CIC; Janine Chapman, RN, BSN; Gwen Cunningham, RN, BSN, CIC; Mary Dahlmann; Elizabeth DeHaan; Mario Javier DeLuca, MD; Richard J. Duma, MD, PhD; LeAnn Ellingson, RN, BSN, CIC; Jeffrey Engel, MD; Pam Falk, MPH; W. Lee Fanning, MD; Christine Filippone; Brenda Grant, RN; Bonnie Greene, MLT (ASCP), SSH; Robert Grisnak, RN; Peg Janasie; Carol Jarvis, CIC; Stuart Johnson, MD; Najwa A. Khuri-Bulos, MD; Joan Kies, RN; Mary J. K. Kim, MSPH, CIC; Brian Koll, MD; Kenji Kono, MD; Wesley Kozinn, MD; Mary Kundus, RN, CIC; Jane Lane, RN; James W. Lederer, MD; Francis J. G. Liu, MD; Carlo Marena, MD, PhD; Linda Matrician, RN, CIC; Jean Maurice, RN; Malkanthie I. McCormick, MD; Clifford McDonald, MD; Gerry Mcllvenny; Kelley Melton, BS, RN, CIC; Ziad A. Memish, MD; Juan Menares, MD; Leonard Mermel, DO, SCM; Paul M. Newell, MD; Catherine O'Neill, RN; Chik Hyun Pai, MD, PhD; Steve Parenteau, MT (ASCP), MS; Michael F. Parry, MD; Cresio Romeu Pereira, MD, MSC; Robert L. Pinsky, MD; Didier Pittet, MD, MS; Jerome Robert, MD; Debra A. Runyan; Barbara Russell, RN, MPH, ACRN, CIC; Ann Schlimm, RN; Jacquelyn Seibert, RN; G. Merrill Shore, MD; Claudia Vallone Silva, RN; Bryan Simmons, MD; Marjeta Skerl, MD; Edward T. M. Smyth, MD; Alice Stankus, RN, CIC; Connie Steed, RN, BSN, CIC; Christopher J. Sullivan, MD; Joseph R. Thurn, MD, MPH; Martin Topiel, MD; Antoni Trilla, MD, PhD; Prity L. Vaidya, MD; Bonnie Viergutz, RN, CIC; Merceditas S. Villanueva, MD; Carol Ward, RN, CIC; Chatrchai Watanakunakorn, MD; Stefan Weber, MD, MS; Sharon Welbel, MD; Donna Winborne, RN, BSN; Mary Wisniewski, RN, MSN; Edward Wong, MD; and Kathryn Zink.

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