Reduction of the catheter-related bloodstream infections in critically ill patients

Introduction

The objective of our study was to determine the utility of a multiple system intervention to reduce catheter-related bloodstream infections (CR-BSI) in an ICU.

Methods

We carried out a prospective cohort study in a medical and surgical ICU. We determined the rate of CR-BSI per 1,000 catheter-days during the application of an evidence-based intervention used to decrease the CR-BSI in 2007 (March to December) compared with the rate during the same period in 2006 in which we just applied conventional measures of prevention. During the intervention period we applied five measures: giving educational sessions about how to insert and maintain central catheters, cleaning the skin with chlorhexidine, filling in a checklist during the insertion of the catheter, using the subclavian vein as the preferred site and avoiding the femoral site if possible, and removing unnecessary catheters. CR-BSI were defined as the recovery of the same organism (same species, same antibiotic susceptibility profile) from the catheter tip and blood cultures.

Results

During the control and intervention periods we registered 4,289 versus 4,174 patient-days and 3,572 versus 3,296 catheter-days, respectively. During the intervention period eight CR-BSI were diagnosed compared with 24 CR-BSI in the control period. The mean incidence rate of CR-BSI was 6.7/1,000 catheter-days in the control period and 2.4/1,000 catheter-days in the intervention period (RR = 0.3; 95% CI = 0.1 to 0.7; P = 0.03). A nursing intervention during the filling of the checklist was required in 17.7% of the insertions. The ratio of use of the catheter was 81.5% during the control period and 80.6% in the intervention period without significant differences between periods.

Conclusion

The implementation of a multiple system intervention with an evidence-based measure significantly reduces the CR-BSI in our ICU.