Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit.
OBJECTIVE
The purpose of the study was to determine whether an education initiative aimed at improving central venous catheter insertion and care could decrease the rate of primary bloodstream infections.


METHODS
Pre- and postintervention observational study.


METHODS
Eighteen-bed surgical/burn/trauma intensive care unit (ICU) in an urban teaching hospital.


METHODS
A total of 4,283 patients were admitted to the ICU between January 1, 1998, and December 31, 2000.


METHODS
A program primarily directed toward registered nurses was developed by a multidisciplinary task force to highlight correct practice for central venous catheter insertion and maintenance. The program consisted of a 10-page self-study module on risk factors and practice modifications involved in catheter-related infections as well as a verbal in-service at staff meetings. Each participant was required to take a pretest before taking the study module and an identical test after its completion. Fact sheets and posters reinforcing the information in the study module were also posted throughout the ICU.


RESULTS
Seventy-four primary bloodstream infections occurred in 6874 catheter days (10.8 per 1000 catheter days) in the 18 months before the intervention. After the implementation of the education module, the number of primary bloodstream infections fell to 26 in 7044 catheter days (3.7 per 1000 catheter days), a decrease of 66% (p < .0001). The estimated cost savings secondary to the decreased infection rate for the 18 months after the intervention was between $185,000 and $2.808 million.


CONCLUSIONS
A focused intervention primarily directed at the ICU nursing staff can lead to a dramatic decrease in the incidence of primary bloodstream infections. Educational programs may lead to a substantial decrease in cost, morbidity, and mortality attributable to central venous catheterization.
Coopersmith
Craig M
CM
Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. coopersmithc@msnotes.wustl.edu
Rebmann
Terri L
TL
Zack
Jeanne E
JE
Ward
Myrna R
MR
Corcoran
Roslyn M
RM
Schallom
Marilyn E
ME
Sona
Carrie S
CS
Buchman
Timothy G
TG
Boyle
Walter A
WA
Polish
Louis B
LB
Fraser
Victoria J
VJ
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004502:Education, Medical, Continuing / Q000379:methods; D004509:Education, Nursing, Continuing / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D000078329:Workforce