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?
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.
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
- Multicentre. Collaborative Cohort study
- 103 ICU s in Michigan, 2004 – 2005
- Population: Adult ICUs
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
- 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
- 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.
- 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
A reduction in rate of infection by 66% at 16-18 months after intervention.
A good evidence of improved patient care and cost effectiveness.