title: The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico.
abstract: OBJECTIVE
  To ascertain the effect of an infection control program including process control on intensive care unit (ICU) rates of intravascular device (IVD)-associated bloodstream infection (BSI).
  
  
  METHODS
  Two level III adult ICUs in one public university hospital in Mexico: one medical surgical ICU and one neurosurgical ICU. POPULATION STUDY: All adult patients admitted to study units who had a central venous catheter (CVC) in place for at least 24 hrs.
  
  
  METHODS
  A prospective before/after trial in which rates of IVD-associated BSI are determined during a period of active surveillance without process control (phase 1) were compared with rates of IVD-associated BSI after implementing an infection control program applying process control (phase 2).
  
  
  RESULTS
  Six hundred five IVD-days were accumulated in phase 1, and 2824 IVD-days were accumulated during phase 2. Compliance with CVC site care and hand hygiene improved significantly from baseline during the study period: placing a gauze dressing over the catheter insertion site (99.24% vs. 86.69%, respectively; relative risk [RR] = 1.14; 95% confidence interval [CI] = 1.07-1.22; p = .0000), proper use of gauze for vascular catheter insertion site (97.87% vs. 84.21%, respectively; RR = 1.16; 95% CI = 1.09-1.24; p = .0000), documentation of the duration of the administration set of the vascular catheter (93.85% vs. 40.69%, respectively; RR = 2.34; 95% CI = 2.14-2.56; p = .0000), and hand hygiene before contact with the patient (84.9% vs. 62%, respectively; RR = 1.37; 95% CI = 1.21-1.51; p = .0000). Overall rates of IVD-associated BSI were lowered significantly from baseline rates after implementation of process control (19.5 vs. 46.3 BSIs per 1000 IVD-days, respectively; RR = 0.42; 95% CI = 0.27-0.66; p = .0001). Overall rates of crude unadjusted mortality were lowered significantly from baseline rates (48.5% vs. 32.8% per 100 discharges, respectively; RR = 0.68; 95% CI = 0.50-0.31; p = .01).
  
  
  CONCLUSIONS
  Implementation of an infection control program utilizing education, process control, and performance feedback was associated with significant reductions in rates of IVD-associated BSI and mortality.
authors.affiliation: General Hospital, Mexico City, Mexico.
authors.forename: Francisco
authors.initials: F
authors.lastname: Higuera
authors.forename: Victor Daniel
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Pablo
authors.initials: P
authors.lastname: Duarte
authors.forename: Javier
authors.initials: J
authors.lastname: Ruiz
authors.forename: Guillermo
authors.initials: G
authors.lastname: Franco
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D008800:Mexico / Q000453:epidemiology; D011446:Prospective Studies