A multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection

Abstract

This study was conducted to investigate decreases in catheter-related bloodstream infections (CRBSIs) through an evidence-based multimodal intervention. This was a prospective interventional study of neonates with a central venous catheter (CVC) from a neonatal intensive care unit database, involving implementation of a multimodal approach to central venous catheter hub care using 2% chlorhexidine in 70% isopropyl alcohol and education of medical staff by audiovisual presentations. CRBSI rates in the pre-intervention period and postintervention period were compared. A total of 373 patients with a CVC (163 in the preintervention period and 210 in the postintervention period) were studied. Patient demographic and clinical characteristics were similar in the 2 periods. Extremely low birth weight infants constituted 40% of the cohort in the preintervention period and 38% of the cohort in the postintervention period. The CRBSI rate in patients with a umbilical artery catheter and an umbilical vein catheter decreased from 15/1000 catheter-days to 10/1000 catheter-days (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.17-0.91). The CRBSI rate in patients with a peripherally inserted central catheter decreased from 23/1000 catheter-days to 10/1000 catheter-days (OR, 0.33; 95% CI, 0.12-0.91). These decreased CRBSI rates were sustained despite high device utilization. The incidence of gram-negative septicemia also decreased. Ten CRBSIs were prevented by this multimodal approach, representing significant health care cost savings. This study demonstrates significant decreases in CRBSI rate for all catheter types and birth weight categories associated with the multimodal intervention. Audiovisual education is an effective tool for practice change. Reeducation and compliance monitoring should be part of all nosocomial infection prevention strategies, resulting in significant savings in health care costs.