title: Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina.
abstract: OBJECTIVE
  Our aim was to ascertain the effect of an infection control program, using education and performance feedback on intensive care units, for intravascular device (IVD)-associated bloodstream infection (BSI).
  
  
  METHODS
  Within 4 level III, adult, intensive care units in Argentina, all admitted, adult patients with a central vascular catheter in place for at least 24 hours were included. This was a prospective before-and-after trial in which rates of IVD-associated BSI determined during a period of active surveillance without education or performance feedback (phase 1) were compared after sequential implementation of an infection control program using education (phase 2) and performance feedback (phase 3).
  
  
  RESULTS
  A total of 1219 IVD days were accumulated in phase 1; 586 during phase 2; and 4140 during phase 3. Compliance with central vascular catheter--site care improved significantly from baseline during the study period. Overall rates of IVD-associated BSI were lowered significantly from baseline after sequential implementation of education and performance feedback (11.10 vs 46.63 BSI/1000 IVD days; relative risk=0.25; 95% confidence interval=0.17-0.36; P<.0001). Rates of IVD-associated BSI decreased significantly after implementation of an educational program (phase 1 to phase 2) (relative risk 0.37; confidence interval 0.19-0.73; P=.0026) and further reductions were seen after implementation of a performance feedback program (phase 2 to phase 3), although the reduction did not reach statistical significance (9.9 vs 17.06 BSI/1000 IVD days; relative risk 0.58; confidence interval 0.29-1.18; P=.11). Additional analysis of the data using chi2 for trends demonstrated that sequential implementation of an education and performance feedback program resulted in a significant trend toward reduced rates of IVD-associated BSI (P<.001).
  
  
  CONCLUSIONS
  Implementation of an infection control program, using education and performance feedback, resulted in significant reductions in rates of IVD-associated BSI.
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, Bernal Medical Center, Buenos Aires, Argentina.
authors.forename: Victor Daniel
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Sandra
authors.initials: S
authors.lastname: Guzman
authors.forename: Stella Maris
authors.initials: SM
authors.lastname: Pezzotto
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Crnich
mesh_terms: D000368:Aged; D001118:Argentina; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017848:Blood-Borne Pathogens; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004496:Education, Continuing; D005246:Feedback; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies