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Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention

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Abstract

In this study, we aimed to determine the utility of a multiple system intervention to reduce catheter-related bloodstream infections (CR-BSI) in our intensive care unit (ICU). A prospective cohort study was undertaken in the medical and surgical ICU at a university hospital. We applied five measures: educational sessions about inserting and maintaining central venous catheters, skin cleaning with chlorhexidine, a checklist during catheter insertion, subclavian vein insertion and avoiding femoral insertion whenever possible, and removing unnecessary catheters. We determined the rate of CR-BSI per 1,000 catheter-days during the intervention (March to December 2007) and compared it with the rate during the same period in 2006 in which we applied only conventional preventive measures. CR-BSI was defined as the recovery of the same organism (same species, same antibiotic susceptibility profile) from catheter tip and blood cultures. We registered 4,289 patient-days and 3,572 catheter-days in the control period and 4,174 patient-days and 3,296 catheter-days in the intervention period. No significant differences in the number of patients with central venous catheters during the two periods were observed: catheters were used in 81.5% of patients during the control period and in 80.6% of patients during the intervention period. During the control period, 24 CR-BSI were diagnosed (6.7/1,000 catheter-days); during the intervention period, 8 CR-BSI were diagnosed (2.4/1,000 catheter-days) (relative risk 0.36; 95% confidence interval [CI] 0.16 to 0.80; p = 0.015). Nurses interrupted the procedure to correct at least one aspect when completing the checklist in 17.7% of insertions. In conclusion, a multiple system intervention applying evidence-based measures reduced the incidence of CR-BSI in our ICU.

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Conflicts of interest

All authors report no conflicts of interest relevant to this article except David Suarez, who was supported by a research grant from Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Spain, and the Departament de Salut, Generalitat de Catalunya (FIS ECA07/041).

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Authors and Affiliations

  1. Critical Care Department, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Sabadell, Spain

    R. Peredo, C. Sabatier, A. Villagrá, J. González, C. Hernández, F. Pérez & J. Vallés

  2. Epidemiology and Assessment Unit, Parc Taulí Foundation, Autonomous University of Barcelona, Sabadell, Spain

    D. Suárez

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  1. R. Peredo
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  2. C. Sabatier
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  3. A. Villagrá
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  4. J. González
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  5. C. Hernández
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  6. F. Pérez
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  7. D. Suárez
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  8. J. Vallés
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Correspondence to R. Peredo.

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Peredo, R., Sabatier, C., Villagrá, A. et al. Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention. Eur J Clin Microbiol Infect Dis 29, 1173–1177 (2010). https://doi.org/10.1007/s10096-010-0971-6

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  • DOI: https://doi.org/10.1007/s10096-010-0971-6

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