An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center.
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.
Warren
David K
DK
Washington University School of Medicine, Saint Louis, MO 63110, USA. dwarren@im.wustl.edu
Zack
Jeanne E
JE
Cox
Michael J
MJ
Cohen
Max M
MM
Fraser
Victoria J
VJ
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