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Effectiveness of stepwise interventions targeted to decrease central catheter-associated bloodstream infections*

Munoz-Price, L. Silvia MD; Dezfulian, Cameron MD; Wyckoff, Mary PhD, ACNP, BC, CCNS, FNP-BC, NNP, FAANP; Lenchus, Joshua D. DO; Rosalsky, Mara RN; Birnbach, David J. MD, MPH; Arheart, Kristopher L. EdD

doi: 10.1097/CCM.0b013e31823e9f5b
Clinical Investigations

Objective: Determine the impact of three stepwise interventions on the rate of central catheter-associated bloodstream infections.

Design: Quasi-experimental study.

Setting: Three surgical intensive care units (general surgery, trauma, and neurosurgery) at a 1500-bed county teaching hospital in the Miami metro area.

Patients: All consecutive central catheter-associated bloodstream infection cases as determined by the Infection Control Department.

Interventions: Three interventions aimed at catheter maintenance were implemented at different times in the units: chlorhexidine “scrub-the-hub,” chlorhexidine daily baths, and daily nursing rounds aimed at assuring compliance with an intensive care unit goal-oriented checklist.

Measurements and Main Results: The primary outcome was the monthly intensive care unit rate of central catheter-associated bloodstream infections (infections per 1000 central catheter days). Over 33 months of follow-up (July 2008 to March 2011), we found decreased rates in each of the three intensive care units evaluated during the interventions, especially after implementation of chlorhexidine daily baths. Rates in unit A decreased from a rate of 8.6 to 0.5, unit B from 6.9 to 1.6, and unit C from 7.8 to 0.6. Secondary bloodstream infection rates remained unchanged throughout the observation period in units A and B; however, unit C had a decrease in its rates over time.

Conclusions: We report the progressive reduction of central catheter-associated bloodstream infection rates after the stepwise implementation of chlorhexidine “scrub-the-hub” and daily baths in surgical intensive care units, suggesting effectiveness of these interventions.

Supplemental Digital Content is available in the text.

From the Departments of Medicine (LSMP, JDL),Public Health and Epidemiology (LSMP, DJB), Surgery (MW), and Anesthesiology (JDL, DJB), Division of Biostatistics (KLA), University of Miami Miller School of Medicine, Jackson Memorial Hospital (LSMP, MR), Miami, FL; and the Department of Critical Care Medicine (CD), University of Pittsburgh, Pittsburgh, PA.

*See also p. 1659.

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The authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins