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A Multicenter Intervention to Prevent Catheter‐Associated Bloodstream Infections

David K. Warren , MD, MPH, Sara E. Cosgrove , MD, Daniel J. Diekema , MD, Gianna Zuccotti , MD, Michael W. Climo , MD, Maureen K. Bolon , MD, Jerome I. Tokars , MD, MPH, Gary A. Noskin , MD, Edward S. Wong , MD, Kent A. Sepkowitz , MD, Loreen A. Herwaldt , MD, Trish M. Perl , MD, MSc, Steven L. Solomon , MD, Victoria J. Fraser , MD and Prevention Epicenter Program
Infection Control and Hospital Epidemiology
Vol. 27, No. 7 (July 2006), pp. 662-669
DOI: 10.1086/506184
Stable URL: http://www.jstor.org/stable/10.1086/506184
Page Count: 8
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A Multicenter Intervention to Prevent Catheter‐Associated Bloodstream Infections
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Abstract

Background.  Education‐based interventions can reduce the incidence of catheter‐associated bloodstream infection. The generalizability of findings from single‐center studies is limited. Objective.  To assess the effect of a multicenter intervention to prevent catheter‐associated bloodstream infections. Design.  An observational study with a planned intervention. Setting.  Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers. Patients.  Patients admitted during the study period. Intervention.  Updates of written policies, distribution of a 9‐page self‐study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence‐based guidelines regarding central venous catheter (CVC) insertion and care. Measurements.  Standard data collection tools and definitions were used to measure the process of care (ie, the proportion of nontunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter‐associated bloodstream infection. Results.  Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% (relative ratio, 0.73; 95% confidence interval [CI], 0.61‐0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% (relative ratio, 1.29; 95% CI, 1.17‐1.42), and the overall rate of catheter‐associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter‐days (relative rate, 0.79; 95% CI, 0.67‐0.93). The effect of the intervention varied among individual units. Conclusions.  An education‐based intervention that uses evidence‐based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter‐associated bloodstream infection rates.

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