Article Text
Abstract
Introduction Central-venous-catheter (CVC)-related bloodstream infection (CRBSI) is a complication of intensive care stay which can have important adverse consequences for both patient and institution. There are a number of evidence-based interventions that reduce CRBSI, but it is recognised that consistently applying the best evidence every time is a challenge.
Methods The authors set out to reduce CRBSI and introduced interventions in our intensive care unit (ICU) over a 4-year period using a quality improvement approach. In a setting supportive to change and improvement, the authors established infection surveillance and introduced bundles of care processes relating to insertion and maintenance of CVCs. The changes were supported by educational interventions. The authors measured care processes and outcomes, and used statistical process control charts to illustrate changes. The final 18 months of the work was performed in the context of a national safety improvement programme (The Scottish Patient Safety Programme).
Results Following interventions, the annual CRBSI rate fell from 3.4 to 0/1000 patient days with zero episodes during the final 19 months of the study.
Conclusions The authors describe a significant reduction in CRBSI for the first time in a UK ICU. The authors summarised and simplified what to do, measured and provided feedback on outcomes, and improved expectations of performance standards for care processes. The authors believe that these approaches are worthy of serious consideration elsewhere.
- Nosocomial infections
- patient safety
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Footnotes
Part of this work was previously reported as an abstract at the International Forum on Quality and Safety in Healthcare (Berlin, March 2009).
Funding Health Protection Scotland provided funding for a nurse salary for the second year of the project. Health Protection Scotland, Clifton House, 1–7 Clifton Place, Glasgow G3 7LN.
Competing interests AGL has recently completed a Scottish Patient Safety Programme Fellowship. SM is currently undertaking the same. LB is Nursing Lead for the Critical Care work stream of the Scottish Patient Safety Programme at Stirling Royal Infirmary.
Provenance and peer review Not commissioned; externally peer reviewed.