Use of central venous catheter-related bloodstream infection prevention practices by US hospitals.
OBJECTIVE
To examine the extent to which US acute care hospitals have adopted recommended practices to prevent central venous catheter-related bloodstream infections (CR-BSIs).


METHODS
Between March 16, 2005, and August 1, 2005, a survey of infection control coordinators was conducted at a national random sample of nonfederal hospitals with an intensive care unit and more than 50 hospital beds (n=600) and at all Department of Veterans Affairs (VA) medical centers (n=119). Primary outcomes were regular use of 5 specific practices and a composite approach for preventing CR-BSIs.


RESULTS
The overall survey response rate was 72% (n=516). A higher percentage of VA compared to non-VA hospitals reported using maximal sterile barrier precautions (84% vs 71%; P=.01); chlorhexidine gluconate for insertion site antisepsis (91% vs 69%; P<.001); and a composite approach (62% vs 44%; P=.003) combining concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Those hospitals having a higher safety culture score, having a certified infection control professional, and participating in an infection prevention collaborative were more likely to use CR-BSI prevention practices.


CONCLUSIONS
Most US hospitals are using maximal sterile barrier precautions and chlorhexidine gluconate, 2 of the most strongly recommended practices to prevent CR-BSIs. However, fewer than half of non-VA US hospitals reported concurrent use of maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes. Wider use of CR-BSI prevention practices by hospitals could be encouraged by fostering a culture of safety, participating in infection prevention collaboratives, and promoting infection control professional certification.
Krein
Sarah L
SL
Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. skrein@umich.edu
Hofer
Timothy P
TP
Kowalski
Christine P
CP
Olmsted
Russell N
RN
Kauffman
Carol A
CA
Forman
Jane H
JH
Banaszak-Holl
Jane
J
Saint
Sanjay
S
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000209:etiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003625:Data Collection; D006761:Hospitals / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D007362:Intensive Care Units; D016015:Logistic Models; D014481:United States
D000890:Anti-Infective Agents; C010882:chlorhexidine gluconate; D002710:Chlorhexidine