Three years experience in implementing HICPAC recommendations for the reduction of central venous catheter-related bloodstream infections.

Garcia R, Jendresky L, Landesman S, Maher A, Nicolas F. Three years experience in implementing HICPAC recommendations for the reduction of central venous catheter-related bloodstream infections. Manag Infect Control. 2003;10:42-49.

Background: An estimated 250,000 central venous catheter-related bloodstream infections (CRBSIs) occur annually in the United States.

Study Objective: Determine the effectiveness of infection control interventions published in the medical literature and by the Centers for Disease Control (CDC).

Methods: Collection of CRBSI incidence between January 1999 and December 2002 using CDC definitions of infection. Interventions included:

  • Targeted Education and Awareness programs for residents, anesthesiologists and nurses
  • Conversion from silver-chlorhexidine (CHG) to silver-platinum catheters
  • Use of a maximal barrier kit containing sterile drape, gown, mask, gloves and wound dressing
  • Use of 2% CHG + 70% alcohol antiseptic for skin preparation

Endpoint: CRBSI rate compared to pre-intervention baseline period (Jan.-Dec. 1999).

Results:

  • 3,079 patients with 31, 445 catheter days were evaluated in the study
  • Mean pre-intervention CRBSI rate (baseline) was 15 cases/1000 catheter days
  • All interventions reduced CRBSI rates by 89.3%
  • During the 39-month intervention period, 237 cases of CRBSI were avoided
  • Estimated annual saving ranges from $2,519,084 to $4,088,000 due to decreased CRBSIs

Discussion:

  • Implementation of well-supported interventions can dramatically reduce CRBSI rates
  • Three of the four recommendations used in this study evolved to a 1A ranking in the 2002 CDC guidelines
  • Individual interventions have been associated with reduced CRBSI rates, but the combination of several interventions produced a cumulative reduction in infection

Conclusions:

  • Four key interventions resulted in avoidance of 237 CRBSI over 39 months
  • Reduced CRBSI rates resulted in annual estimated cost savings ranging from $2,519,084 to $4,088,000

Three years experience in implementing HICPAC recommendations for the reduction of central venous catheter-related bloodstream infections.

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