title: Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil.
abstract: BACKGROUND
  Central venous catheter-associated bloodstream infections (CVC-BSI) are a frequent cause of morbidity and mortality in intensive care settings. Many strategies have been used to decrease the risk of CVC-BSI; however, few studies have explored the educational intervention as an approach to reduce the CVC-BSI rates.
  
  
  OBJECTIVE
  The purpose of this study was to determine the impact of an educational program targeted to specific points observed during CVC care practices on decreasing CVC-BSI in a medical intensive care unit.
  
  
  METHODS
  An educational program was developed by a multidisciplinary task force to highlight correct practices for CVC care. Relative risk ratios, 95% confidence intervals, and P values were determined for all primary and secondary outcomes. The chi 2 linear test for trends of CVC-BSI rates was performed during the study period and the following year.
  
  
  RESULTS
  Forty-eight primary bloodstream infections occurred in 2450 catheter-days (20 per 1000 catheter-days) in the 16 months before the intervention. After the educational intervention and policy changes such as standardized povidone-iodine use during dressing care, the number of CVC-BSI dropped to 16 in 1381 catheter-days (11 per 1000 catheter-days), a decrease of 40%. The rate of CVC-BSI remained almost the same, 22 in 1701 catheter-days (12 per 1000 catheter-days), during the following year after the educational intervention (P = .07). The distribution of pathogens was different comparing the pre- and postintervention period. Staphylococcus aureus was the most common pathogen in preintervention, decreasing significantly during the study period (P = .02). The adhesion to the overall catheter care policy improved significantly in the postintervention period (P < .01).
  
  
  CONCLUSIONS
  A multiple approach included an educational strategy, targeted to specific problems observed during a careful evaluation of CVC care practices, and policy changes can decrease rates of CVC-BSI. However, despite the good results, our rates are still high, and reinforcement of CVC care practices will be continued.
authors.affiliation: Infection Control Hospital Committee, Hospital das Clínicas, Department of Infectious Diseases, University of São Paulo, Brazil.
authors.forename: Renata D
authors.initials: RD
authors.lastname: Lobo
authors.forename: Anna Sara
authors.initials: AS
authors.lastname: Levin
authors.forename: Laura M Brasileiro
authors.initials: LM
authors.lastname: Gomes
authors.forename: Rosa
authors.initials: R
authors.lastname: Cursino
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.forename: Valquiria B
authors.initials: VB
authors.lastname: Figueiredo
authors.forename: Leandro
authors.initials: L
authors.lastname: Taniguchi
authors.forename: Cilmara G
authors.initials: CG
authors.lastname: Polido
authors.forename: Silvia Figueiredo
authors.initials: SF
authors.lastname: Costa
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D001938:Brazil / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D004496:Education, Continuing; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D007362:Intensive Care Units / Q000592:standards*; D016134:Organizational Policy; D017063:Outcome Assessment, Health Care