Simple interventions with great benefits – why we should “Match Michigan”

Pronovost P, Needham D, Berenholtz S et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine 2006; 355: 2725-2732.

RHH Journal Club. March 7th, 2012. Dr Reshma Bonsale

Full-text article (if available)

Can a central venous catheter care bundle reduce catheter-associated infections?

Primary hypothesis:

The rate of catheter-related bloodstream infection would be reduced during the first 3 months after implementation of the study intervention as compared with baseline.

Secondary hypothesis:

The observed decrease in the rate of infection between 0 and 3 months after implementation of the study intervention would be sustained during the subsequent observation period

Study design:

  • Multicentre. Collaborative Cohort study
  • 103 ICU s in Michigan, 2004 – 2005

Methodology:

  • Population: Adult ICUs
  • Intervention:

1. Hand washing

2. Full-barrier precautions

3. Chlorhexidine for skin

4. Avoid femoral site

5. Removing unnecessary catheters

  • Primary outcome: quarterly rate of catheter-related bloodstream infection

Data Categorization:

  • Definition of bloodstream central catheter

Investigators  – Trained hospital based infection control practitioner

Clinicians – ICU trained operators following set guidelines

  • Confounding factors considered
  • Follow up complete 18 months

Results:

  • 375,757 catheter days
  • The mean of rate of catheter infections reduced from 7.7/1000 catheter days to 2.3 at 0-3 months (p<0.002)
  • A mean of 1.4 was observed in the following 18 months
  • The median rate reduced from 2.7 to 0.

Limitations:

  • All ICUs did not implement at the same time, but results were consistent over 18 months
  • Lack of baseline data on infections, underreporting
  • Data on organisms was not collected
  • Clinicians’ compliance was not evaluated
  • Individual components of intervention not evaluated

 

Overall:

A reduction in rate of infection by 66% at 16-18 months after intervention.

A good evidence of improved patient care and cost effectiveness.

 

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