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Reducing Catheter-Related Bloodstream Infections

In one U.S. state, systematic implementation of a set of five interventions led to a striking reduction in infection rates.

Catheter-related bloodstream infections are a preventable cause of morbidity and mortality. In this study, 67 hospitals in Michigan — accounting for 85% of intensive care unit (ICU) beds in that state — participated in a statewide patient safety initiative, one component of which was to reduce rates of central venous catheter–related bloodstream infections in the ICU.

Each hospital systematically implemented and monitored a set of five interventions in its ICUs: hand washing, using full-barrier precautions during insertion of central venous catheters, cleansing the catheter insertion site with chlorhexidine, avoiding femoral vein catheter sites, and removing unnecessary catheters. Before the intervention, the median rate of catheter-related bloodstream infections was 2.7 per 1000 catheter-days in these ICUs. After the intervention was implemented, and for 18 months thereafter, the median rate dropped to 0; the mean rate was 7.7 at baseline, and decreased to 1.4.

Comment: In this study, a statewide intervention resulted in a striking reduction in catheter-related bloodstream infections. This trial was not randomized, but the results are convincing: The intervention incorporated a set of evidence-based procedures known to prevent bloodstream infections. Although no formal cost analysis was done, the authors present data suggesting that this intervention would likely save money in addition to reducing morbidity.

— Allan S. Brett, MD

Published in Journal Watch General Medicine December 27, 2006

Citation(s):

Pronovost P et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006 Dec 28; 355:2725-32.

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