Reduction of central venous catheter associated blood stream infections following implementation of a resident oversight and credentialing policy

Abstract

BackgroundThis study assesses the impact that a resident oversight and credentialing policy for central venous catheter (CVC) placement had on institution-wide central line associated bloodstream infections (CLABSI). We therefore investigated the rate of CLABSI per 1,000 line days during the 12 months before and after implementation of the policy.MethodsThis is a retrospective analysis of prospectively collected data at an academic medical center with four adult ICUs and a pediatric ICU. All patients undergoing non-tunneled CVC placement were included in the study. Data was collected on CLABSI, line days, and serious adverse events in the year prior to and following policy implementation on 9/01/08.ResultsA total of 813 supervised central lines were self-reported by residents in four departments. Statistical analysis was performed using paired Wilcoxon signed rank tests. There were reductions in median CLABSI rate (3.52 vs. 2.26; p = 0.015), number of CLBSI per month (16.0 to 10.0; p = 0.012), and line days (4495 vs. 4193; p = 0.019). No serious adverse events reported to the Pennsylvania Patient Safety Authority.ConclusionsImplementation of a new CVC resident oversight and credentialing policy has been significantly associated with an institution-wide reduction in the rate of CLABSI per 1,000 central line days and total central line days. No serious adverse events were reported. Similar resident oversight policies may benefit other teaching institutions, and support concurrent organizational efforts to reduce hospital acquired infections.

Update on bloodstream infections in ICUs

“…The importance of adequate staffing and its relationship to BSIs has been reported [62]. Recent studies have also shown that structured training of medical trainees can lower risk for catheter-related infection [63,64].…”

Impacto Da Implementação Dos Bundles Na Redução Das Infecções Da Corrente Sanguínea: Uma Revisão Integrativa

“…To ensure the quality of these programs, the following should be included: adequate CVC insertion and maintenance techniques, periodic assessment of knowledge, adherence to measures, infection surveillance and reporting, feedback on infection reduction and audit of the processes and results. 7,[42][43] An educational intervention in the multidisciplinary team in the ICU of a Saint Louis hospital in the United States, which lasted for three years, addressed the recommended measures during the insertion and maintenance of the CVC, and resulted in the a 66% reduction of bloodstream infection. 44 It is therefore also important to only designate trained professionals who demonstrate competency for the insertion and maintenance of the CVC, 7 in addition to providing training with a global and multidisciplinary approach, including behavioral and educational interventions for the whole team involved in catheter insertion and maintenance.…”

Estratégia multimodal para prevenção da infecção da corrente sanguínea relacionada ao cateter venoso central: uma revisão integrativa

“…No período pós-intervenção em 100% dos estudos avaliaram o impacto das estratégias implementadas sobre as taxas de infecção da corrente sanguínea relacionada ao CVC e posteriormente realizaram um feedback dos resultados e relatórios de vigilância a toda equipe. Embora em muitos casos sejam negligenciados dentro das instituições de saúde, deve-se realizar a vigilância, notificação das infecções, feedback dos resultados obtidos e auditoria dos processos e resultados, pois esses auxiliam no processo de ensino-aprendizagem, fornece continuamente, informações relacionadas ao desempenho profissional e sobre as práticas institucionais, além de favorecer a melhoria no trabalho, a qualidade dos cuidados e segurança do paciente [34][35][36] . Observou-se nos estudos uma redução das taxas de infecção da corrente sanguínea relacionada ao CVC após o período de intervenção.…”