Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina

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Abstract

Objective

Our aim was to ascertain the effect of an infection control program, using education and performance feedback on intensive care units, for intravascular device (IVD)-associated bloodstream infection (BSI).

Methods

Within 4 level III, adult, intensive care units in Argentina, all admitted, adult patients with a central vascular catheter in place for at least 24 hours were included. This was a prospective before-and-after trial in which rates of IVD-associated BSI determined during a period of active surveillance without education or performance feedback (phase 1) were compared after sequential implementation of an infection control program using education (phase 2) and performance feedback (phase 3).

Results

A total of 1219 IVD days were accumulated in phase 1; 586 during phase 2; and 4140 during phase 3. Compliance with central vascular catheter—site care improved significantly from baseline during the study period. Overall rates of IVD-associated BSI were lowered significantly from baseline after sequential implementation of education and performance feedback (11.10 vs 46.63 BSI/1000 IVD days; relative risk = 0.25; 95% confidence interval = 0.17-0.36; P<.0001). Rates of IVD-associated BSI decreased significantly after implementation of an educational program (phase 1 to phase 2) (relative risk 0.37; confidence interval 0.19-0.73; P = .0026) and further reductions were seen after implementation of a performance feedback program (phase 2 to phase 3), although the reduction did not reach statistical significance (9.9 vs 17.06 BSI/1000 IVD days; relative risk 0.58; confidence interval 0.29-1.18; P = .11). Additional analysis of the data using χ2 for trends demonstrated that sequential implementation of an education and performance feedback program resulted in a significant trend toward reduced rates of IVD-associated BSI (P<.001).

Conclusion

Implementation of an infection control program, using education and performance feedback, resulted in significant reductions in rates of IVD-associated BSI.

Section snippets

Setting

The study was conducted in 2 medical centers in Buenos Aires, Argentina (Bernal Medical Center and Colegiales Medical Center). Each center has an infection control team comprised of a medical doctor (with formal education and background in internal medicine, infectious diseases, and hospital epidemiology) and an infection control nurse.10

Bernal Medical Center is a private, 150-bed hospital with 1 medical/surgical ICU (17 beds) and 1 coronary ICU (15 beds). Colegiales Medical Center is a

Results

During the study period (April 1999 to July 2001), 840 adult patients in the study ICUs required CVCs and all of these patients were enrolled in the study. Patients from phase 1 were very similar to patients from phases 2 and 3 with regard to sex, age, diabetes mellitus, cancer, and HIV (Table 2).

During the study periods we evaluated compliance with catheter care for a total of 347 observations in phase 1; 169 observations in phase 2; and 5165 observations in phase 3. Compliance with IVD site

Discussion

Patients who are critically ill often require central venous access for the administration of fluids, medicines, and blood products. Unfortunately the use of CVCs is associated with a considerable risk of infection.16., 17. When infection does occur, studies have repeatedly demonstrated an increased length of hospitalization, excess costs,5., 7. and an increased attributable mortality.7., 8. For example, Digiovine et al6 found that IVD-associated BSIs resulted in an excess length of

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    Supported in part by a grant from Baxter Healthcare.

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