37. Translating Evidence into Practice to Prevent Central Venous Catheter-associated Bloodstream Infections: A Systems-based Intervention

Young EM, Commiskey ML, Wilson SJ. Translating evidence into practice to prevent central venous catheterassociated bloodstream infections: a systems-based intervention. Am J Infect Control. 2006;34(8):503-506

Background
The central venous catheter (CVC) is a necessary, yet very risky medical device. This study aimed to carry out a systems-based intervention designed to facilitate the use of maximal sterile barrier precautions and the use of chlorhexidine for skin antisepsis during insertion of CVCs.

Methods
Wishard Memorial Hospital is a 300-bed county hospital with a level one trauma center.  It is located on the Indiana University Medical Center campus and is a major teaching hospital of the Indiana School of Medicine. The study took place in the 22-bed, combined medical-surgical intensive care unit (ICU).  The study population included all patients in the ICU whom a CVC was inserted.  A standard CVC kit in use before the intervention included a small sterile drape (24” by 36” with a 4” fenestration) and 10% povidone-iodine for skin antisepsis.  They special ordered a custom CVC kit which, instead, included a large sterile drape (41" by 55" with a 4") fenestration and 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin antisepsis.  Both kits contained the exact same first-generation chlorhexidine-silver sulfadiazine-impregnated triple-lumen catheter.  The infection control educational sessions required all of the medicine and surgery residents prior to each rotation remained the same throughout the study period.

Measurements
The following data was collected: CVC-associated BSIs, CVC-days, patient-days, total ICU admissions and surgical ICU admissions.  The primary variable was the CVC-associated BSI rate per 1000 CVC-days as defined by the NNISS. For purposes of cost analysis, they used a $10,000 excess direct cost per CVC-associated BSI.  The study period included the quarterly CVC-associated BSI rate in the 15 months prior to the intervention and the same for the 15 months after they instituted use of the customized kit.

Results
The mean quarterly CVC-associated BSI rate decreased from 11.3 per 1000 CVC-days before the intervention to 3.7 per 1000 CVC-days after the intervention (P<.01).  Assuming the direct costs of at least $10,000 per CVC-BSI, they calculated an annual savings to the hospital of approximately $348,000.

Conclusions
Translating scientific evidence into practice is an important aspect of infection control.  This article demonstrates that a systems-based intervention at a resource-poor hospital was followed by a significant and sustained decrease in CVC-associated BSI rate, resulting in improved patient safety and decreased cost of care.

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