Preventing central venous catheter-associated primary bloodstream infections: characteristics of practices among hospitals participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) study.
OBJECTIVE
To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI.


METHODS
This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected.


METHODS
Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites).


METHODS
Process information was obtained for 3,320 CVC insertions with an average of 58.2 (+/- 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information.


RESULTS
Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs.


CONCLUSIONS
Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.
Braun
Barbara I
BI
Division of Research, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois 60181, USA.
Kritchevsky
Stephen B
SB
Wong
Edward S
ES
Solomon
Steve L
SL
Steele
Lynn
L
Richards
Cheryl L
CL
Simmons
Bryan P
BP
D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019538:Health Care Surveys; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000458:organization & administration*; D007362:Intensive Care Units; D009741:Nursing Staff, Hospital / Q000600:supply & distribution; D016134:Organizational Policy; D010561:Personnel Staffing and Scheduling; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology; D000078329:Workforce