Preventing catheter-associated infections in the Pediatric Intensive Care Unit: impact of an educational program surveying policies for insertion and care of central venous catheters in a Brazilian teaching hospital.
OBJECTIVE
To determine the impact of an educational program on the prevention of central venous catheter-related infections in a Brazilian Pediatric Intensive Care Unit.


METHODS
All patients admitted to the unit between February 2004 and May 2005 were included in the cohort study in a longitudinal assessment. An educational program was developed based on the Centers for Disease Control and Prevention recommendations for prevention of catheter-associated infections and was adapted to local conditions and resources after an initial observational phase. Incidence of catheter-associated infections was measured by means of on-site surveillance.


RESULTS
One hundred eighteen nosocomial infections occurred in 253 patients (46.6 infections per 100 admissions) and in 2,954 patient-days (39.9 infections per 1,000 patient-days). The incidence-density of catheter infections was 31.1 episodes per 1.000 venous central catheter-days before interventions, and 16.5 episodes per 1,000 venous central catheter-days afterwards (relative risk 0.53 [95% CI 0.28-1.01]). Corresponding rates for exit-site catheter infections were 8.0 and 2.5 episodes per 1,000 venous central catheter-days [0.32 (0.07-1.49)], and the rates for bloodstream infections were 23.1 and 13.9 episodes per 1,000 venous central catheter-days, before and after interventions [0.61 (0.32-1.14)].


CONCLUSIONS
A prevention strategy targeted at the insertion and maintenance of vascular access can decrease rates of vascular-access infections in pediatric intensive care unit.
Infectious Disease Pediatric Department, Universidade Federal de São Paulo, SP, Brazil. mabramczyk@ig.com.br
Marcelo Luiz
ML
Abramczyk
Werter B
WB
Carvalho
Eduardo A S
EA
Medeiros
D001938:Brazil; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods; D007318:Inservice Training / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D008137:Longitudinal Studies; D015397:Program Evaluation