Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Arch Surg. 2004 Feb;139(2):131-6.

The impact of bedside behavior on catheter-related bacteremia in the intensive care unit.

Author information

  • 1Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. coopersmithc@msnotes.wustl.edu

Abstract

HYPOTHESIS:

The success of an educational program in July 1999 that lowered the catheter-related bloodstream infection (CRBSI) rate in our intensive care unit (ICU) 3-fold is correlated with compliance with "best-practice" behaviors.

DESIGN:

Before-after trial.

SETTING:

Surgical ICU in a referral hospital.

PATIENTS:

A random sample underwent bedside audits of central venous catheter care (n = 187). All ICU admissions during a 39-month period (N = 4489) were prospectively followed for bacteremia.

INTERVENTIONS:

On the basis of audit results in December 2000, a behavioral intervention was designed to improve compliance with evidenced-based guidelines of central venous catheter management.

MAIN OUTCOME MEASURES:

Compliance with practices known to decrease CRBSI. Secondary outcome was CRBSI rate on all ICU patients.

RESULTS:

Multiple deficiencies were identified on bedside audits 18 months after the previous educational program. After the implementation of a separate behavioral intervention in July 2001, a second set of bedside audits in December 2001 demonstrated improvements in documenting the dressing date (11% to 21%; P<.001) and stopcock use (70% to 24%; P<.001), whereas nonsignificant trends were observed in hand hygiene (17% to 30%; P>.99) and maximal sterile barrier precautions (50% to 80%; P =.29). Appropriate practice was observed before and after the behavioral intervention in catheter site placement, dressing type, absence of antibiotic ointment, and proper securing of central venous catheters. Thirty-two CRBSIs occurred in 9353 catheter-days 24 months before the behavioral intervention compared with 17 CRBSIs in 6152 catheter-days during the 15 months after the intervention (3.4/1000 to 2.8/1000 catheter-days; P =.40).

CONCLUSIONS:

Although a previous educational program decreased the CRBSI rate, this was associated with only modest compliance with best practice principles when bedside audits were performed 18 months later. A behavioral intervention improved all identified deficiencies, leading to a nonsignificant decrease in CRBSIs.

PMID:
14769568
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk