Major Article
Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil

https://doi.org/10.1016/j.ajic.2004.05.003Get rights and content

Background

Central venous catheter-associated bloodstream infections (CVC-BSI) are a frequent cause of morbidity and mortality in intensive care settings. Many strategies have been used to decrease the risk of CVC-BSI; however, few studies have explored the educational intervention as an approach to reduce the CVC-BSI rates.

Objective

The purpose of this study was to determine the impact of an educational program targeted to specific points observed during CVC care practices on decreasing CVC-BSI in a medical intensive care unit.

Methods

An educational program was developed by a multidisciplinary task force to highlight correct practices for CVC care. Relative risk ratios, 95% confidence intervals, and P values were determined for all primary and secondary outcomes. The χ2 linear test for trends of CVC-BSI rates was performed during the study period and the following year.

Results

Forty-eight primary bloodstream infections occurred in 2450 catheter-days (20 per 1000 catheter-days) in the 16 months before the intervention. After the educational intervention and policy changes such as standardized povidone-iodine use during dressing care, the number of CVC-BSI dropped to 16 in 1381 catheter-days (11 per 1000 catheter-days), a decrease of 40%. The rate of CVC-BSI remained almost the same, 22 in 1701 catheter-days (12 per 1000 catheter-days), during the following year after the educational intervention (P = .07). The distribution of pathogens was different comparing the pre- and postintervention period. Staphylococcus aureus was the most common pathogen in preintervention, decreasing significantly during the study period (P = .02). The adhesion to the overall catheter care policy improved significantly in the postintervention period (P < .01).

Conclusion

A multiple approach included an educational strategy, targeted to specific problems observed during a careful evaluation of CVC care practices, and policy changes can decrease rates of CVC-BSI. However, despite the good results, our rates are still high, and reinforcement of CVC care practices will be continued.

Section snippets

Setting

The study was conducted in a 7-bed medical intensive care unit in the 1000-bed teaching hospital of the University of São Paulo, São Paulo, Brazil. All adult patients admitted to the 7-bed medical intensive care unit (ICU) between January 2001 and April 2002 (control period) and May 2002 and December 2002 were prospectively surveyed for CVC-BSI and included in the study. The rate of CVC-BSI was also evaluated during the following year after the educational intervention. The institutional review

Results

Surveillance for nosocomial infections has been carried out in the hospital since 1993. Three hundred sixteen patients were admitted to the medical intensive care unit during the 1-year preintervention period (January 2001 to April 2002) and 190 patients during the 8-month postintervention period. During the following year after the educational intervention, 266 patients were admitted in the study unit.

The entire unit staff answered the pretest questions (Table 1). The major problem with CVC

Discussion

Bloodstream infection is an important cause of nosocomial infection all over the world.1, 2, 3 However, few data have been published concerning Latin America.

In 1997, the nosocomial infection control committee at our hospital developed a CVC-BSI prevention guideline; however, the pretest and the preintervention observation period showed that compliance to the guideline was low. The pretest found major problems concerning skin preparation during CVC insertion, disinfection of CVC during

References (24)

  • N.P. O'Grady et al.

    Guidelines for prevention of intravascular catheter-related infections

    MMWR Recomm Rep

    (2002)
  • R.J. Pratt et al.

    Guideline for preventing infections associated with the insertion and maintenance of central venous catheters

    J Hosp Infect

    (2001)
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