Evaluation of interventions to reduce catheter-associated bloodstream infection: continuous tailored education versus one basic lecture.
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.
Lobo
Renata D
RD
Infection Control Nosocomial Committee, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Levin
Anna S
AS
Oliveira
Maura S
MS
Gomes
Laura M B
LM
Gobara
Satiko
S
Park
Marcelo
M
Figueiredo
Valquíria B
VB
de Vasconcelos Santos
Edzangela
E
Costa
Silvia F
SF
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