[Impact of a prevention program for catheter-related bloodstream infection in the intensive care unit of a tertiary hospital].
BACKGROUND
Catheter-related bloodstream infection (CR-BSI) is a cause of morbidity and mortality in intensive care units, and the optimal approach for preventing these infections is not well defined. Comparison of CR-BSI rates with those provided by programs such as the National Nosocomial Infection Surveillance System (NNISS) from the USA and the Spanish National Nosocomial Infection Surveillance Study (ENVIN), enable determination of the need to implement control measures. In 2000, we found that the CR-BSI rates in UCIs of our hospital were much higher than the data reported by ENVIN.


OBJECTIVE
To assess the impact of implementing a protocol for proper use of intravascular catheters on CR-BSI rates in the intensive care unit (ICU) of a tertiary hospital.


METHODS
Prospective study of patients admitted to the ICUs of a tertiary hospital in the months of May and June, from 2000 to 2004. In 2001, a CR-BSI prevention program including aspects related to catheter insertion and maintenance in ICU patients was implemented. We calculated infection rates per 1000 days of catheter use in all the 2-month periods studied, and compared the 2000 and 2004 results by analysis of the odds ratios and confidence intervals.


RESULTS
A total of 923 patients were included. Mean age was 58.7 years (SD: 15.4), mean ICU stay was 11.6 days (SD: 11.4), mean SAPSII was 28.2 (SD: 15.9), and mortality was 20.5%. There was a significant reduction in CR-BSI rates from 13.3 episodes per 1000 days of catheter use in the first period to 3.21 in the last period (OR=3.53, 95% CI: 2.36-5.31).


CONCLUSIONS
Application of a prevention program for CR-BSI and a system for monitoring BSI rates led to a significant, sustained reduction in these infections.
Esteve
Francisco
F
Servicio de Medicina Intensiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. f.esteve@bellvitgehospital.cat
Pujol
Miquel
M
Ariza
Javier
J
Gudiol
Francisco
F
Verdaguer
Ricard
R
Cisnal
María
M
Argerich
María José
MJ
Mañez
Rafael
R
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002404:Catheterization / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000458:organization & administration* / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015397:Program Evaluation; D011446:Prospective Studies; D012308:Risk Management; D013030:Spain / Q000453:epidemiology
D000900:Anti-Bacterial Agents