Blue Ribbon Abstract Award, New Investigator Award: Reduction of the Central Venous Catheter-Associated Bloodstream Infection Rate in a Neurological/Neurosurgical Intensive Care Unit

Abstract

BACKGROUND/OBJECTIVES: In 2002, routine surveillance of a 20-bed neurological/neurosurgical intensive care unit (NNICU) at Barnes-Jewish Hospital, a 1442-bed tertiary care university hospital, revealed a mean central venous catheter (CVC) bloodstream infection (BSI) rate of 9.9 infections per 1000 CVC days. This was higher than the 2002 National Nosocomial Infections Surveillance System pooled mean of 4.7/1000 CVC days. CVC BSIs are associated with increased morbidity and mortality rates and prolonged hospital stay. Risk factors for CVC BSI include breaks in aseptic technique during CVC insertion or site care and non-occlusive dressings. In accordance with evidence-based guidelines, interventions relating to hand hygiene, strict aseptic CVC insertion techniques, and meticulous CVC site care were implemented to lower the CVC–associated BSI rate. METHODS: The population consisted of NNICU patients with a CVC placed during their hospital stay which developed a CVC–associated BSI greater than 48 hours post insertion. The Centers for Disease Control (CDC) definitions for primary CVC–associated nosocomial BSI were used. During January–March 2003, staff participated in a mandatory educational program focusing on CDC hand hygiene recommendations and encouraging use of alcohol foam. In March 2003, use of chlorhexidine gluconate (CHG) was implemented for CVC insertion and site care, and incoming residents began receiving a self-study module on prevention of CVC–associated BSIs. RESULTS: Twenty-six primary BSIs occurred in 2699 catheter days during January–December, 2002 (9.9 BSI/1000CVC days). Primary BSIs decreased to thirteen in 2796 catheter days during January–December, 2003 (4.6 BSI/1000CVC days), a decrease of 54% (p=0.03). CONCLUSIONS: Educational interventions focusing on hand hygiene and aseptic technique for CVC insertion and site care, combined with implementation of CHG for CVC insertion and site care, successfully lowered the rate of CVC–associated BSIs in a NNICU.