A multicenter intervention to prevent catheter-associated bloodstream infections.
BACKGROUND
Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited.


OBJECTIVE
To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections.


METHODS
An observational study with a planned intervention.


METHODS
Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers.


METHODS
Patients admitted during the study period.


METHODS
Updates of written policies, distribution of a 9-page self-study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence-based guidelines regarding central venous catheter (CVC) insertion and care.


METHODS
Standard data collection tools and definitions were used to measure the process of care (ie, the proportion of nontunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter-associated bloodstream infection.


RESULTS
Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% (relative ratio, 0.73; 95% confidence interval [CI], 0.61-0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% (relative ratio, 1.29; 95% CI, 1.17-1.42), and the overall rate of catheter-associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter-days (relative rate, 0.79; 95% CI, 0.67-0.93). The effect of the intervention varied among individual units.


CONCLUSIONS
An education-based intervention that uses evidence-based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter-associated bloodstream infection rates.
Warren
David K
DK
Department of Medicine, Washington University School of Medicine, Saint Louis, MO 63110, USA. dwarren@im.wustl.edu
Cosgrove
Sara E
SE
Diekema
Daniel J
DJ
Zuccotti
Gianna
G
Climo
Michael W
MW
Bolon
Maureen K
MK
Tokars
Jerome I
JI
Noskin
Gary A
GA
Wong
Edward S
ES
Sepkowitz
Kent A
KA
Herwaldt
Loreen A
LA
Perl
Trish M
TM
Solomon
Steven L
SL
Fraser
Victoria J
VJ
D000046:Academic Medical Centers; D002408:Catheters, Indwelling / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D018805:Sepsis / Q000517:prevention & control*