title: Evaluation of interventions to reduce catheter-associated bloodstream infection: continuous tailored education versus one basic lecture.
abstract: BACKGROUND
  This study evaluated the impact of 2 models of educational intervention on rates of central venous catheter-associated bloodstream infections (CVC-BSIs).
  
  
  METHODS
  This was a prospective observational study conducted between January 2005 and June 2007 in 2 medical intensive care units (designated ICU A and ICU B) in a large teaching hospital. The study was divided into in 3 periods: baseline (only rates were evaluated), preintervention (questionnaire to evaluate knowledge of health care workers [HCWs] and observation of CVC care in both ICUs), and intervention (in ICU A, tailored, continuous intervention; in ICU B, a single lecture). The preintervention and intervention periods for each ICU were compared.
  
  
  RESULTS
  During the preintervention period, 940 CVC-days were evaluated in ICU A and 843 CVC-days were evaluated in ICU B. During the intervention period, 2175 CVC-days were evaluated in ICU A and 1694 CVC-days were evaluated in ICU B. Questions regarding CVC insertion, disinfection during catheter manipulation, and use of an alcohol-based product during dressing application were answered correctly by 70%-100% HCWs. Nevertheless, HCWs' adherence to these practices in the preintervention period was low for CVC handling and dressing, hand hygiene (6%-35%), and catheter hub disinfection (45%-68%). During the intervention period, HCWs' adherence to hand hygiene was 48%-98%, and adherence to hub disinfection was 82%-97%. CVC-BSI rates declined in both units. In ICU A, this decrease was progressive and sustained, from 12 CVC-BSIs/1000 CVC-days at baseline to 0 after 9 months. In ICU B, the rate initially dropped from 16.2 to 0 CVC-BSIs/1000 CVC-days, but then increased to 13.7 CVC-BSIs/1000 CVC-days.
  
  
  CONCLUSIONS
  Personal customized, continuous intervention seems to develop a "culture of prevention" and is more effective than single intervention, leading to a sustained reduction of infection rates.
authors.affiliation: Infection Control Nosocomial Committee, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Renata D
authors.initials: RD
authors.lastname: Lobo
authors.forename: Anna S
authors.initials: AS
authors.lastname: Levin
authors.forename: Maura S
authors.initials: MS
authors.lastname: Oliveira
authors.forename: Laura M B
authors.initials: LM
authors.lastname: Gomes
authors.forename: Satiko
authors.initials: S
authors.lastname: Gobara
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.forename: Valquíria B
authors.initials: VB
authors.lastname: Figueiredo
authors.forename: Edzangela
authors.initials: E
authors.lastname: de Vasconcelos Santos
authors.forename: Silvia F
authors.initials: SF
authors.lastname: Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D002648:Child; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D016469:Fungemia / Q000382:microbiology / Q000517:prevention & control*; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult