title: Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach.
abstract: OBJECTIVE
  Bloodstream infections associated with catheters were the most common nosocomial infections in one paediatric intensive care unit in 1994-7, with rates well above the national average.
  
  
  METHODS
  Clinical data were collected prospectively to assess the rates of infection from 1994 onwards. The high rates in 1994-7 led to the stepwise introduction of interventions over a five year period. At quarterly intervals, prospective data continued to be collected during this period and an additional three year follow-up period.
  
  
  METHODS
  A 292 bed tertiary care children's hospital.
  
  
  METHODS
  We aimed to reduce our infection rates to below the national mean rates for similar units by 2000 (a 25% reduction).
  
  
  METHODS
  A stepwise introduction of interventions designed to reduce infection rates, including maximal barrier precautions, transition to antibiotic impregnated central venous catheters, annual handwashing campaigns, and changing the skin disinfectant from povidone-iodine to chlorhexidine. Effects of change Significant decreases in rates of infection occurred over the intervention period. These were sustained over the three year follow-up. Annual rates decreased from 9.7/1000 days with a central venous catheter in 1997 to 3.0/1000 days in 2005, which translates to a relative risk reduction of 75% (95% confidence interval 35% to 126%), an absolute risk reduction of 6% (2% to 10%), and a number needed to treat of 16 (10 to 35).
  
  
  CONCLUSIONS
  A stepwise introduction of interventions leading to a greater than threefold reduction in nosocomial infections can be implemented successfully. This requires a multidisciplinary team, support from hospital leadership, ongoing data collection, shared data interpretation, and introduction of evidence based interventions.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 800 Marshall Street, Slot 512-3, Little Rock, AR 72202, USA. bhuttaadnant@uams.edu
authors.forename: Adnan
authors.initials: A
authors.lastname: Bhutta
authors.forename: Craig
authors.initials: C
authors.lastname: Gilliam
authors.forename: Michele
authors.initials: M
authors.lastname: Honeycutt
authors.forename: Stephen
authors.initials: S
authors.lastname: Schexnayder
authors.forename: Jerril
authors.initials: J
authors.lastname: Green
authors.forename: Michele
authors.initials: M
authors.lastname: Moss
authors.forename: K J S
authors.initials: KJ
authors.lastname: Anand
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001130:Arizona; D017848:Blood-Borne Pathogens; D002404:Catheterization; D002648:Child; D002710:Chlorhexidine; D003428:Cross Infection / Q000517:prevention & control*; D004202:Disinfectants; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D004202:Disinfectants; D002710:Chlorhexidine