An effective intervention program that resulted in a sustained significant reduction in catheter-associated bloodstream infections in three intensive care units (ICUs)

Abstract

BACKGROUND: Central venous lines are necessary to provide medical treatment to severely ill patients, but they can lead to complications, including catheter-associated bloodstream infections (CA-BSIs). CA-BSIs are associated with attributable costs averaging $34,000-$56,000 per incident, increased length of stay up to 7.6 days, and mortality rates of 12%-25%. In 2001, our ICU CA-BSI rates exceeded NNIS' 90th percentile. METHODS: An intervention program to decrease CA-BSIs was implemented in a midwestern 767-bed acute care, non-teaching hospital in January 2002. All patients with central lines from three ICUs were included: 23-bed surgical ICU (SICU), 22-bed coronary care unit (CCU), and 8-bed cardiovascular ICU (CVICU). CDC definitions for central lines and CA-BSI were used; only BSIs related to central line catheters and ICU stay were included. The intervention program included staff education on current CA-BSI rates and CA-BSI prevention, development of a physician catheter-insertion documentation form that replaced a dictated op note, changing skin prep routine from betadine to CHG and alcohol, and creating prearranged insertion kits. Insertion kits included supplies for maximum barriers (large drape, dressing materials, sterile gown, hair cover, and mask) and were attached to central line kits to facilitate staff use. RESULTS: Baseline rates (2001) for the ICUs: SICU, 6.3; CCU, 9.7; CVICU, 5.9 (all rates are per 1000 catheter days). Post-intervention rates were as follows. 2002 rates: SICU, 3.74; CCU 2.9; CVICU 2.1. 2003 rates: SICU, 2.63; CCU, 0.65; CVICU, 0.2004 (through October): SICU, 2.14; CCU 1.13; CVICU, 0.82. Aggregate data revealed an overall reduction of CA-BSI rates by 59.1% across the three ICUs (p=0.00009). ICU rates are now below NNIS's 25th percentile in the CVICU, right at the 25th in the CCU, and at the 50th in the SICU. CONCLUSION: Our hospital was able to drop ICU CA-BSI rates by almost 60% through implementation of an effective and innovative intervention program consisting of education, maximum barriers, change in skin prep, and development of a new documentation form. The physician catheter-insertion form has improved documentation and facilitated surveillance. Competition due to sharing of ICU infection rates may have contributed to this program. Although an antimicrobial-coated catheter was introduced during this time, it is not felt that it played a significant role in the outcome.