ArticlesImpact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care
Introduction
Insertion of intravascular devices is among the main causes of nosocomial infections,1 which exacerbate morbidity and hospital costs in intensive-care units (ICUs).2, 3 Various strategies have been used to decrease the risk of vascular-access infections, including prevention efforts targeted at the materials from which catheters are made, and catheter care.4, 5, 6, 7 So far, only a few studies have used a multiple-strategy approach to decrease infection rates and to explore the possible benefits of the combined measures on rates of vascular-access infections.8, 9 Hitherto, no large-scale study has assessed the impact of an overall management approach in the adult critical-care setting.
We did a prospective cohort study, and implemented a multimodal, multidisciplinary prevention strategy to decrease rates of vascular-access infections and to assess the impact of the strategy on the incidence of ICU-acquired infections.
Section snippets
Patients
The University of Geneva Hospital is a 1500-bed primary-care and tertiary-care centre. An average of 1400 patients are admitted each year to the 18-bed medical ICU for a mean length of stay of 4 days. All adult patients admitted to the medical ICU for more than 48 h between October, 1995, and February, 1997 (control period), were prospectively surveyed for nosocomial infections by standard methods.10 The intervention programme was implemented in March, 1997, and its impact was measured during
Results
2104 patients were surveyed during the control period, and 1050 during the intervention period (a total of 13 200 patient-days). The groups were similar with respect to baseline characteristics, underlying disease, and intrinsic susceptibility to infection (table 2). A fifth of the patients required mechanical ventilation (similar proportions in both groups). The duration of ICU stay was similar among patients within the same disease categories. Monthly Project Research in Nursing scores were
Discussion
Our results demonstrate the impact of a multiple-approach intervention strategy on rates of bloodstream and catheter-related infection, as well as on the overall incidence of ICU-acquired infections. Although infection rates before the intervention (ie, 6·6 episodes of microbiologically documented bloodstream infections per 1000 CVC-days) were within the accepted limits,17, 18, 19 our experience shows that, as postulated,1 a large proportion of nosocomial infections related to extrinsic factors
References (26)
- et al.
Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters
Lancet
(1991) - et al.
Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention program
J Hosp Infect
(1998) - et al.
CDC definitions for nosocomial infections
Am J Infect Control
(1988) - et al.
Infectious rates of central venous pressure catheters: comparison between newly placed catheters and those that have been changed
Mayo Clin Proc
(1996) - et al.
Infections due to infusion therapy
- et al.
Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality
JAMA
(1994) Nosocomial bloodstream infections in the critically ill
JAMA
(1994)- et al.
Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion
Infect Control Hosp Epidemiol
(1994) - et al.
Catheter-related septicemia: risk reduction
Infect Med
(1996) - et al.
A comparison of two antimicrobial-impregnated central venous catheters
N Engl J Med
(1999)