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A Multicenter Intervention to Prevent Catheter-Associated Bloodstream Infections

Published online by Cambridge University Press:  07 April 2017

David K. Warren*
Affiliation:
Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
Sara E. Cosgrove
Affiliation:
Department of Public Health and Hygiene, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland
Daniel J. Diekema
Affiliation:
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
Gianna Zuccotti
Affiliation:
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
Michael W. Climo
Affiliation:
Department of Internal Medicine, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
Maureen K. Bolon
Affiliation:
Department of Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinoi
Jerome I. Tokars
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Gary A. Noskin
Affiliation:
Department of Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinoi
Edward S. Wong
Affiliation:
Department of Internal Medicine, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia
Kent A. Sepkowitz
Affiliation:
Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
Loreen A. Herwaldt
Affiliation:
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
Trish M. Perl
Affiliation:
Department of Public Health and Hygiene, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland
Steven L. Solomon
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Victoria J. Fraser
Affiliation:
Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
*
Washington University School of Medicine, Campus Box 8051, 660 S. Euclid Avenue, Saint Louis, MO 63110 (dwarren@im.wustl.edu)

Abstract

Background.

Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited.

Objective.

To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections.

Design.

An observational study with a planned intervention.

Setting.

Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers.

Patients.

Patients admitted during the study period.

Intervention.

Updates of written policies, distribution of a 9-page self-study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence-based guidelines regarding central venous catheter (CVC) insertion and care.

Measurements.

Standard data collection tools and definitions were used to measure the process of care (ie, the proportion of non-tunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter-associated bloodstream infection.

Results.

Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% (relative ratio, 0.73; 95% confidence interval [CI], 0.61-0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% (relative ratio, 1.29; 95% CI, 1.17-1.42), and the overall rate of catheter-associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter-days (relative rate, 0.79; 95% CI, 0.67-0.93). The effect of the intervention varied among individual units.

Conclusions.

An education-based intervention that uses evidence-based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter-associated bloodstream infection rates.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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