title: Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections.
abstract: OBJECTIVE
  To study the impact of a teaching intervention on the rate of central venous catheter-related bloodstream infections (CRBSI) in intensive care patients.
  
  
  METHODS
  Prospective before/after interventional cohort study on medical and surgical intensive care units.
  
  
  METHODS
  University hospital with five adult intensive care units.
  
  
  METHODS
  All patients with a central venous catheter on the five ICUs from September to December 2003 (baseline period) and from March to July 2004 (intervention period).
  
  
  METHODS
  Educational program with teaching of hand hygiene, standards of catheter care, and preparation of intravenous drugs.
  
  
  RESULTS
  The primary outcome variable was the rate of CRBSIs per 1000 catheter days during a baseline period of 4 months and an intervention period of 5 months. The secondary outcome variable was compliance with hand hygiene. Of the patients, 499 patients with 6200 catheter days in the baseline period and 500 patients with 7279 catheter days were monitored in the intervention period. The incidence density of CRBSI decreased from 3.9 per 1000 catheter days in the preintervention phase to 1.0 per 1000 catheter days in the intervention phase (p < 0.001). The risk for CRBSI was significantly higher in the baseline period in both univariate and multivariate analysis. Other independent risk factors were hospitalization in the medical ICU and male gender. Time to CRBSI was significantly longer in the intervention period (median 9 days vs. 6.5 days, respectively; p = 0.02). Compliance with hand hygiene improved slightly from 59% in the baseline period to 65% in the intervention period, but the rate of correct performance of the practice increased from 22.5% to 42.6% (p = 0.003).
  
  
  CONCLUSIONS
  Evidence-based catheter-care procedures, guided by healthcare workers' perceptions and including bedside teaching, reduce significantly the CRBSI rate and demonstrate that improving catheter care has a major impact on its prevention.
authors.affiliation: Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland. walter.zingg@hcuge.ch
authors.forename: Walter
authors.initials: W
authors.lastname: Zingg
authors.forename: Alexander
authors.initials: A
authors.lastname: Imhof
authors.forename: Marco
authors.initials: M
authors.lastname: Maggiorini
authors.forename: Reto
authors.initials: R
authors.lastname: Stocker
authors.forename: Emanuela
authors.initials: E
authors.lastname: Keller
authors.forename: Christian
authors.initials: C
authors.lastname: Ruef
mesh_terms: D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D015331:Cohort Studies; D003422:Critical Care; D003479:Curriculum; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D015994:Incidence; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D010564:Personnel, Hospital / Q000193:education; D015397:Program Evaluation; D017592:Skin Care