Chest
Volume 126, Issue 5, November 2004, Pages 1612-1618
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Clinical Investigations in Critical Care
The Effect of an Education Program on the Incidence of Central Venous Catheter-Associated Bloodstream Infection in a Medical ICU

https://doi.org/10.1378/chest.126.5.1612Get rights and content

Objective:

To determine whether an education initiative could decrease the rate of catheter-associated bloodstream infection.

Design:

Preintervention and postintervention observational study.

Setting:

The 19-bed medical ICU in a 1,400-bed university-affiliated urban teaching hospital.

Patients:

Between January 2000 and December 2003, all patients admitted to the medical ICU were surveyed prospectively for the development of catheter-associated bloodstream infection.

Intervention:

A mandatory education program directed toward ICU nurses and physicians was developed by a multidisciplinary task force to highlight correct practices for the prevention of catheter-associated bloodstream infection. The program consisted of a 10-page self-study module on risk factors and practice modifications involved in catheter-related bloodstream infections and in-services at scheduled staff meetings. Each participant was required to complete a pretest before reviewing the study module and an identical test after completion of the study module. Fact sheets and posters reinforcing the information in the study module were also posted throughout the ICU.

Measurements and main results:

Seventy-four episodes of catheter-associated bloodstream infection occurred in 7,879 catheter-days (9.4 per 1,000 catheter-days) in the 24 months before the introduction of the education program. Following implementation of the intervention, the rate of catheter-associated bloodstream infection decreased to 41 episodes in 7,455 catheter days (5.5 per 1,000 catheter-days) [p = 0.019]. The estimated cost savings secondary to the decreased rate of catheter-associated bloodstream infection for the 24 months following introduction of the education program was between $103,600 and $1,573,000.

Conclusions:

An intervention focused on the education of health-care providers on the prevention of catheter-associated bloodstream infections may lead to a dramatic decrease in the incidence of primary bloodstream infections. Education programs may lead to a substantial decrease in medical-care costs and patient morbidity attributed to central venous catheterization when implemented as part of mandatory training.

Section snippets

Study Location and Patients

This study was conducted in a medical ICU at a university-affiliated, urban teaching hospital: Barnes-Jewish Hospital (1,400 beds). The medical ICU (19 beds) is a closed unit with a multidisciplinary team providing patient care under the direction of attending physicians who are board certified in critical care medicine. Nurse staffing is maintained at a ratio of two patients per nurse, and central venous catheters are usually inserted by resident physicians. During a 4-year period (January

Results

During the 24-month preintervention period (calendar years 2000 and 2001), a total of 74 episodes of catheter-associated bloodstream infection occurred during a total of 7,876 central vein catheter-days. This calculated to an infection rate of 9.4 per 1,000 catheter-days. During the postintervention period (calendar years 2002 and 2003), a total of 41 episodes of catheter-associated bloodstream infections were recorded of a total of 7,455 central vein catheter-days. This is equivalent to an

Discussion

Our study demonstrated that an education program directed at nurses and physicians working in the medical ICU setting may significantly reduce the incidence of catheter-associated bloodstream infection. The observed 41.5% decrease in the rate of bloodstream infection from 9.4 per 1,000 catheter-days to 5.5 per 1,000 catheter-days was associated with an estimated cost savings of between $103,600 and $1,573,000. This study demonstrates that an education-based intervention aimed at optimizing the

ACKNOWLEDGMENT

The authors thank Ms. Linda Brockman for assistance in preparing this manuscript, and the nursing staff of the BJH Medical Intensive Care Unit for their clinical efforts.

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    This work was supported by funding from the Centers of Disease Control and Prevention Cooperative Agreement, grant U50/CCU717925, and the Barnes-Jewish Hospital Foundation.

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