title: A central venous line protocol decreases bloodstream infections and length of stay in a trauma intensive care unit population.
abstract: We evaluated the benefit of a central venous line (CVL) protocol on bloodstream infections (BSIs) and outcome in a trauma intensive care unit (ICU) population. We prospectively compared three groups: Group 1 (January 2003 to June 2004) preprotocol; Group 2 (July 2004 to June 2005) after the start of the protocol that included minimizing CVL use and strict universal precautions; and Group 3 (July 2005 to December 2006) after the addition of a line supply cart and nursing checklist. There were 1622 trauma patients admitted to the trauma ICU during the study period of whom 542 had a CVL. Group 3 had a higher Injury Severity Score (ISS) compared with both Groups 2 and 1 (28.3 +/- 13.0 vs 23.5 +/- 11.7 vs 22.8 +/- 12.0, P = 0.0002) but had a lower BSI rate/1000 line days (Group 1: 16.5; Group 2: 15.0; Group 3: 7.7). Adjusting for ISS group, three had shorter ICU length of stay (LOS) compared with Group 1 (12.11 +/- 1.46 vs 18.16 +/- 1.51, P = 0.01). Logistic regression showed ISS (P = 0.04; OR, 1.025; CI, 1.001-1.050) and a lack of CVL protocol (P = 0.01; OR, 0.31; CI, 0.13-0.76) to be independent predictors of BSI. CVL protocols decrease both BSI and LOS in trauma patients. Strict enforcement by a nurse preserves the integrity of the protocol.
authors.affiliation: Virginia Commonwealth University, Richmond, Virginia, USA. tmduane@vcu.edu
authors.forename: Therèse M
authors.initials: TM
authors.lastname: Duane
authors.forename: Holly
authors.initials: H
authors.lastname: Brown
authors.forename: C Todd
authors.initials: CT
authors.lastname: Borchers
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: Ajai K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Michel B
authors.initials: MB
authors.lastname: Aboutanos
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000592:standards*; D002985:Clinical Protocols; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D007902:Length of Stay; D016015:Logistic Models; D011446:Prospective Studies; D014768:Virginia; D014947:Wounds and Injuries / Q000191:economics / Q000628:therapy*