Effectiveness of simple daily sensitization of physicians to the duration of central venous and urinary tract catheterization.
OBJECTIVE
To evaluate the effectiveness of simple daily sensitization of physicians to the duration of central venous and urinary tract catheterization, and impact on infection rates.


METHODS
A prospective, before-after study in a surgical intensive care unit. All consecutive patients who had a central venous catheter (CVC) and/or urinary tract catheter (UTC) were included during two consecutive periods. Period 1 (August 2005 to May 2006) served as the control period. During Period 2 (July 2006 to April 2007), a red square, added to the patient's daily care sheet, questioned the physician about the utility of the CVC and/or UTC. If the response was "No", the CVC and/or the UTC were removed by a nurse.


RESULTS
A total of 1,271 patients were analyzed (Period 1, n = 676; Period 2, n = 595). The duration of catheterization (median [interquartile range]) was significantly reduced in Period 2 compared to Period 1 (from (5 [3-9] to 4 [3-7] days, p < 0.001, for CVC, and from 5 [3-11] to 4 [3-8] days, p < 0.001, for UTC). The incidence and density incidence of CVC infection decreased in Period 2 compared to Period 1 (from 1.8% to 0.3%, p = 0.010, and from 2.8 to 0.7/1,000 CVC-days, p = 0.051) whereas UTC infections were not significantly different (4.3 to 3.0%, p = 0.230, and 5.0 to 4.9/1,000 UTC-days, p = 0.938, respectively).


CONCLUSIONS
A simple daily reminder to physicians on the patients' care sheets decreased the duration of central venous and urinary tract catheterization, and tended to decrease CVC infection rate without affecting UTC infection.
Service de Réanimation Chirurgicale, INSERM U991, Université Rennes 1, Hôpital de Pontchaillou, 2, Rue Henri le Guilloux, 35033, Rennes Cedex 9, France. philippe.seguin@chu-rennes.fr
Philippe
P
Seguin
Bruno
B
Laviolle
Sonia
S
Isslame
Aurélie
A
Coué
Yannick
Y
Mallédant
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods / Q000592:standards; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D017010:Reminder Systems; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects*