An intervention to decrease catheter-related bloodstream infections in the ICU.
BACKGROUND
Catheter-related bloodstream infections occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.


METHODS
We conducted a collaborative cohort study predominantly in ICUs in Michigan. An evidence-based intervention was used to reduce the incidence of catheter-related bloodstream infections. Multilevel Poisson regression modeling was used to compare infection rates before, during, and up to 18 months after implementation of the study intervention. Rates of infection per 1000 catheter-days were measured at 3-month intervals, according to the guidelines of the National Nosocomial Infections Surveillance System.


RESULTS
A total of 108 ICUs agreed to participate in the study, and 103 reported data. The analysis included 1981 ICU-months of data and 375,757 catheter-days. The median rate of catheter-related bloodstream infection per 1000 catheter-days decreased from 2.7 infections at baseline to 0 at 3 months after implementation of the study intervention (P< or =0.002), and the mean rate per 1000 catheter-days decreased from 7.7 at baseline to 1.4 at 16 to 18 months of follow-up (P<0.002). The regression model showed a significant decrease in infection rates from baseline, with incidence-rate ratios continuously decreasing from 0.62 (95% confidence interval [CI], 0.47 to 0.81) at 0 to 3 months after implementation of the intervention to 0.34 (95% CI, 0.23 to 0.50) at 16 to 18 months.


CONCLUSIONS
An evidence-based intervention resulted in a large and sustained reduction (up to 66%) in rates of catheter-related bloodstream infection that was maintained throughout the 18-month study period.
Pronovost
Peter
P
School of Medicine, Johns Hopkins University, Baltimore, USA
Needham
Dale
D
Berenholtz
Sean
S
Sinopoli
David
D
Chu
Haitao
H
Cosgrove
Sara
S
Sexton
Bryan
B
Hyzy
Robert
R
Welsh
Robert
R
Roth
Gary
G
Bander
Joseph
J
Kepros
John
J
Goeschel
Christine
C
D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods* / Q000592:standards; D007318:Inservice Training; D007362:Intensive Care Units / Q000592:standards*; D008824:Michigan / Q000453:epidemiology; D016012:Poisson Distribution; D011785:Quality Assurance, Health Care; D012044:Regression Analysis