Eliminating catheter-related bloodstream infections in the intensive care unit*

Berenholtz, Sean M.; Pronovost, Peter J.; Lipsett, Pamela A.; Hobson, Deborah B.; Earsing, Karen; Farley, Jason E.; Milanovich, Shelley; Garrett‐Mayer, Elizabeth; Winters, Bradford D.; Rubin, Haya R.; Dorman, Todd; Perl, Trish M.

doi:10.1097/01.ccm.0000142399.70913.2f

Cited by 862 publications

(518 citation statements)

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“…The authors of all these studies performed a surveillance with feedback and education programs [15][16][17][18][19][20][21]. Reduction rates of 41% to 100% in CA-BSIs were discussed in further studies [22][23][24]. The elimination of CA-BSIs was achieved with continuous training programs which included lectures, posters, fact sheets, self-study programs for health care workers, and a review with pre-and post-tests [24].…”

Section: Discussionmentioning

confidence: 99%

“…Reduction rates of 41% to 100% in CA-BSIs were discussed in further studies [22][23][24]. The elimination of CA-BSIs was achieved with continuous training programs which included lectures, posters, fact sheets, self-study programs for health care workers, and a review with pre-and post-tests [24]. The duration of 4 years needed for the introduction of these measures as well as their evaluation is one characteristic of the latter.…”

Section: Discussionmentioning

confidence: 99%

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Surveillance with successful reduction of central line-associated bloodstream infections among neutropenic patients with hematologic or oncologic malignancies

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surveillance with successful reduction of central line-associated bloodstream infections among neutropenic patients with hematologic or oncologic malignancies

et al. 2009

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“…17 Adherence to these guidelines has been included in successful quality improvement initiatives. 4,5,18 Compared to internists' adherence to recommendations for infection control reported in another survey, 10 residents who attended our educational session reported more use of large sterile drapes (94% vs. 35%) or masks (75% vs. 66%); however, they were less likely to use a sterile gown (50% vs. 72%). Use of a large sterile drape is common in our hospital, likely because the drape is included in the central venous catheter package.…”

Section: Discussionmentioning

confidence: 65%

“…Most quality improvement initiatives directed at reducing complications associated with central venous catheters have focused on patients in the intensive care unit (ICU). 4,5 However, in some hospitals more central venous catheters are inserted in patients not in the ICU, 6 and practices that increase the risk of complications may be more common on wards. 7 In our hospital, most catheters are placed in the femoral vein.…”

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confidence: 99%

Firm‐based trial to improve central venous catheter insertion practices

Miranda

Trick

Evans

et al. 2007

Journal of Hospital Medicine

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BACKGROUNDCentral venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein.OBJECTIVEDetermine whether a hands‐on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control.DESIGNFirm‐based clinical trial between November 2004 and March 2005.SETTINGGeneral medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital.PARTICIPANTSInternal medicine residents (n = 150).INTERVENTIONBefore their 4‐week rotation, intervention‐firm residents received a lecture and practiced placing catheters in mannequins; control‐firm residents received the usual training.MEASUREMENTSVenous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter‐associated complicationsRESULTSResidents inserted 54 catheters, or 0.24 insertions per resident per 4‐week rotation. There was a nonsignificant decrease in femoral insertions for nondialysis catheters in the intervention group compared to the control group (44% vs. 58%), difference: −14% (95% CI, −52% to 24%). The intervention significantly increased residents' knowledge of complications related to femoral vein catheterization and temporarily increased their confidence about placing internal jugular or subclavian venous catheters. Intervention‐group residents were more likely to use masks during catheterization (risk ratio, 2.2; 95% CI, 1.3‐2.7), but other practices were similar.CONCLUSIONSOur intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills‐building session may have deteriorated given the few clinical opportunities for reinforcement. Journal of Hospital Medicine 2007;2:135–142. © 2007 Society of Hospital Medicine.

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“…3 Several practices have been proposed to reduce the incidence of catheter-related infections. 4,5 Some practices are applicable to the catheter's insertion, others to its maintenance. 6,7 A daily review of the catheter's necessity is basic to maintenance practices.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of unnecessary central venous catheters in critically ill patients: a prospective observational study

Cload

Day

Ilan

2010

Can J Anesth/J Can Anesth

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Introduction Central venous catheters are used commonly in critical care. Evidence-based practices to prevent catheter-related bloodstream infections have been widely promoted. One such practice includes assessing the need for central venous catheters on a daily basis and removing those found to be unnecessary. However, little is known about the adherence to this recommendation. Our objective was to examine the prevalence of unnecessary central venous catheters in our intensive care units. Methods We performed a prospective observational study during 28 consecutive days in two adult intensive care units at an academic medical centre. The principal investigator screened patients daily for the presence of non-tunnelled central venous catheters and assessed whether there was an indication for continued central catheterization. Patients under the age of 18 were excluded, as were those undergoing palliative care. Standardized indications were abstracted from the patient's chart, and the patient's primary nurse was interviewed if there was no indication for central venous catheterization in the chart. If there were multiple catheters or indications, the most appropriate indication was recorded. The end point was to establish whether a patient had an appropriate indication for central catheterization rather than to attribute an indication to each catheter. Results Eighty-one patients experienced a total of 614 days with at least one central venous catheter. Fortyone (50.6%; 95% confidence interval [CI], 39.9-61.3%) of these patients had no indication on at least one central venous catheter day. Of all patient days with central venous catheters, 170 (27.7%; 95% CI, 19.5-37.9%) had no apparent indication. The proportion of patient days with central venous catheters without indication was 4.6 (95% CI, 2.6-8.2; P \ 0.001) times greater in the level-2 unit than in the level-3 unit. Discussion In two academic adult intensive care units, a large proportion of patients with central venous catheters lacked an ongoing indication for their use during a significant period of time. Many patients were exposed to complications from unneeded catheters. Our findings will serve as a baseline for determining the success of qualityimprovement interventions to prevent complications such as catheter-related infections in our program.

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Eliminating catheter-related bloodstream infections in the intensive care unit*

Abstract: Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.

Cited by 862 publications

References 15 publications

Surveillance with successful reduction of central line-associated bloodstream infections among neutropenic patients with hematologic or oncologic malignancies

Surveillance with successful reduction of central line-associated bloodstream infections among neutropenic patients with hematologic or oncologic malignancies

Firm‐based trial to improve central venous catheter insertion practices

Evaluation of unnecessary central venous catheters in critically ill patients: a prospective observational study

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