Eliminating catheter-related bloodstream infections in the intensive care unit.
OBJECTIVE
To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs).


METHODS
Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU.


METHODS
The Johns Hopkins Hospital.


METHODS
All patients with a central venous catheter in the ICU.


METHODS
To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed.


METHODS
The primary outcome variable was the rate of CR-BSIs per 1,000 catheter days from January 1, 1998, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion.


RESULTS
Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and 1,945,922 dollars in additional costs per year in the study ICU.


CONCLUSIONS
Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.
Berenholtz
Sean M
SM
Departments of Anesthesiology/CCM and Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Pronovost
Peter J
PJ
Lipsett
Pamela A
PA
Hobson
Deborah
D
Earsing
Karen
K
Farley
Jason E
JE
Milanovich
Shelley
S
Garrett-Mayer
Elizabeth
E
Winters
Bradford D
BD
Rubin
Haya R
HR
Dorman
Todd
T
Perl
Trish M
TM
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011786:Quality Control; D011787:Quality of Health Care / Q000592:standards*; D018805:Sepsis / Q000517:prevention & control*