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The effect of process control on the incidence of central venous catheter–associated bloodstream infections and mortality in intensive care units in Mexico*

Higuera, Francisco MD; Rosenthal, Victor Daniel MD, MSc, CIC; Duarte, Pablo MD; Ruiz, Javier MD; Franco, Guillermo MD; Safdar, Nasia MD

doi: 10.1097/01.CCM.0000178190.89663.E5
Clinical Investigations
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Purpose: To ascertain the effect of an infection control program including process control on intensive care unit (ICU) rates of intravascular device (IVD)–associated bloodstream infection (BSI).

Setting: Two level III adult ICUs in one public university hospital in Mexico: one medical surgical ICU and one neurosurgical ICU.

Population Study: All adult patients admitted to study units who had a central venous catheter (CVC) in place for at least 24 hrs.

Methods: A prospective before/after trial in which rates of IVD-associated BSI are determined during a period of active surveillance without process control (phase 1) were compared with rates of IVD-associated BSI after implementing an infection control program applying process control (phase 2).

Results: Six hundred five IVD-days were accumulated in phase 1, and 2824 IVD-days were accumulated during phase 2. Compliance with CVC site care and hand hygiene improved significantly from baseline during the study period: placing a gauze dressing over the catheter insertion site (99.24% vs. 86.69%, respectively; relative risk [RR] = 1.14; 95% confidence interval [CI] = 1.07–1.22; p = .0000), proper use of gauze for vascular catheter insertion site (97.87% vs. 84.21%, respectively; RR = 1.16; 95% CI = 1.09–1.24; p = .0000), documentation of the duration of the administration set of the vascular catheter (93.85% vs. 40.69%, respectively; RR = 2.34; 95% CI = 2.14–2.56; p = .0000), and hand hygiene before contact with the patient (84.9% vs. 62%, respectively; RR = 1.37; 95% CI = 1.21–1.51; p = .0000). Overall rates of IVD-associated BSI were lowered significantly from baseline rates after implementation of process control (19.5 vs. 46.3 BSIs per 1000 IVD-days, respectively; RR = 0.42; 95% CI = 0.27–0.66; p = .0001). Overall rates of crude unadjusted mortality were lowered significantly from baseline rates (48.5% vs. 32.8% per 100 discharges, respectively; RR = 0.68; 95% CI = 0.50–0.31; p = .01).

Conclusion: Implementation of an infection control program utilizing education, process control, and performance feedback was associated with significant reductions in rates of IVD-associated BSI and mortality.

From General Hospital (FH, PD, JR, GF), Mexico City, Mexico; Medical College of Buenos Aires (VDR), Buenos Aires, Argentina; and Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School (NS), Madison, WI.

Supported by a grant from Baxter Health Care International (to FH, PD, JR, GF).

Address requests for reprints to: Victor D. Rosenthal, MD, Arengreen 1366, Buenos Aires 1405, Argentina. E-mail: victor_rosenthal@fibertel.com.ar

© 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins