Patient Safety and Quality

Hand washing, barrier protection, and other procedures can reduce catheter-related bloodstream infections in the ICU

Catheter-related bloodstream infections that occur in hospital intensive care units (ICUs) are common, costly (an average cost of $45,000 per infection), and potentially lethal. However, using team leaders to implement recommended infection control procedures reduced catheter-related bloodstream infections in Michigan hospital ICUs by 66 percent, according to a new study.

The study targeted clinicians' use of five evidence-based procedures that are recommended to prevent catheter-related bloodstream infections: hand washing, using full-barrier precautions during the insertion of central venous catheters, cleaning the skin around the catheter insertion site with chlorhexidine, avoiding the femoral site if possible, and removing unnecessary catheters.

Clinicians were educated about infection control practices as well as the harm resulting from catheter-related bloodstream infections. Clinicians were also provided with a central-line cart with necessary supplies, and a checklist to ensure adherence to infection control practices. In nonemergency situations, clinicians were stopped if these practices were not being followed. The removal of unnecessary catheters was discussed at daily rounds, and the teams received feedback regarding the number and rates of infections at monthly and quarterly meetings.

Peter Pronovost, M.D., Ph.D., of Johns Hopkins University School of Medicine, and coinvestigators compared infection rates before, during, and up to 18 months after implementation of the study intervention. The median rate of catheter-related bloodstream infections per 1,000 catheter days decreased from 2.7 infections at baseline to none at 3 months after implementing the infection control intervention. The mean rate per 1,000 catheter days decreased from 7.7 at baseline to 1.4 at 16 to 18 months of followup—a 66 percent sustained reduction. The study was supported by the Agency for Healthcare Research and Quality (HS14246).

See "An intervention to decrease catheter-related bloodstream infections in the ICU," by Dr. Pronovost, Dale Needham, M.D., Ph.D., Sean Berenholtz, M.D., and others, in the December 28, 2006, New England Journal of Medicine 355(26), pp. 2725-2732.

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