Effects of an education: prevention strategy on decreasing catheter-related infections in intensive care

Background

Primary bloodstream infections resulting from central venous catheterization are a leading source of nosocomial infection. The purpose of this study was to investigate whether the implementation of a prevention program aimed at improving central venous catheter (CVC) insertion and care, directed towards ICU doctors and nursing stuff, could decrease the occurrence of catheter-related infections and the frequency of catheter removal and exchange.

Methods

This prospective cohort study was performed in 80 critically ill patients admitted in a 19-bed general intensive care unit at a tertiary center between August 2002 and October 2002. Patients were divided into two groups: Group A, 40 patients (APACHE II 17 ± 4, mean age 49 ± 15 years) were studied in the preintervention period; Group B, 40 patients (APACHE II 17 ± 5, mean age 50 ± 18 years) were studied in the postintervention time. The incidence of catheter-related infections classified as catheter-related bloodstream infection (CRBSI) (definite or probable), exit-site catheter-related infection (CRI) and no CRI (colonized, contaminated, sterile) was measured. The frequency of catheter removal and exchange was also measured in the two groups.

Statistical analysis was computed by paired t test. P < 0.005 was considered significant. The relative risk (RR) was also determined.

Results

The median duration of CVC use was 7.6 ± 1.8 days in Group A and 8 ± 1.9 days in Group B.

We investigated 314 catheter days in Group A and 323 in Group B. Twenty CRI occurred in 80 patients (25 CRI/100 admissions). The incidence rate of CRBSI was 31.8 episodes/1000 catheter days in Group A and 9.3 episodes/1000 catheter days in Group B (RR 0.3). Corresponding rates of exit-site infections were 16 episodes/1000 catheter days and 6 episodes/1000 catheter days, respectively (RR 0.4). The incidence density of catheter colonization was 28.6 episodes/1000 catheter days in Group A and 12.3 episodes/ 1000 catheter days in Group B, while catheter contamination was 25 episodes/1000 catheter days and 12 episodes/1000 catheter days, respectively. After the intervention, the incidence density of exit-site catheter infection decreased by 61% (P < 0.005) and that of bloodstream infection decreased by 71% (P < 0.005)

Fofty-seven catheter exchanges were measured in Group A versus 44 catheter exchanges in Group B, leading to a decrease of 25% (P < 0.005) in the frequency of catheter removal and exchange. The mean length of catheter stay before a new site replacement was 6.9 ± 2.6 days in Group A versus 7.9 ± 2 days in Group B.

Discussion

Our results demonstrate that a focused and multidimensional invention directed at the ICU physicians and nursing staff can lead to a dramatic decrease in the incidence of catheter-related infections.