title: An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center.
abstract: OBJECTIVE
  To evaluate the effectiveness of an evidence-based intervention to prevent catheter-associated bloodstream infections among intensive care unit patients at a nonteaching, community hospital.
  
  
  METHODS
  Nonrandomized pre/post observational trial.
  
  
  METHODS
  Two intensive care units at Missouri Baptist Medical Center, Saint Louis, MO.
  
  
  METHODS
  Nurses and critical care physicians.
  
  
  METHODS
  A ten-page, self-study module on the prevention of catheter-associated bloodstream infections, lectures, and posters given between July and September 1999.
  
  
  METHODS
  The incidence of nosocomial catheter-associated bloodstream infection and patient demographics were measured for patients admitted between March 1998 and July 2000.
  
  
  RESULTS
  Thirty cases of catheter-associated bloodstream infections during 6110 catheter-days were noted in the preintervention period (4.9 cases/1000 catheter-days) vs. 11 cases during the 5210 catheter-days in the postintervention period (2.1 cases/1000 catheter-days). The relative risk for catheter-associated infection in the postintervention period was 0.43 (95% confidence interval, 0.22-0.84). Among catheterized patients, Acute Physiology and Chronic Health Evaluation II score (25.2 preintervention vs. 25.1 postintervention; p =.86), hemodialysis (91 of 647 [14%] patients vs. 69 of 541 [13%]; p =.70), and the mean number of catheter days per patient (9.1 vs. 9.6 days; p =.46) did not differ between the pre- and postintervention periods.
  
  
  CONCLUSIONS
  A focused, educational intervention among nurses and physicians in a nonteaching community hospital resulted in a significant, sustained reduction in the incidence of catheter-associated bloodstream infection.
authors.affiliation: Washington University School of Medicine, Saint Louis, MO 63110, USA. dwarren@im.wustl.edu
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Zack
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cox
authors.forename: Max M
authors.initials: MM
authors.lastname: Cohen
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000706:statistics & numerical data; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003479:Curriculum; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D007318:Inservice Training; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D008923:Missouri; D009741:Nursing Staff, Hospital / Q000193:education*; D011380:Programmed Instructions as Topic; D011446:Prospective Studies