Major article
A multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection

https://doi.org/10.1016/j.ajic.2009.07.014Get rights and content

Background

This study was conducted to investigate decreases in catheter-related bloodstream infections (CRBSIs) through an evidence-based multimodal intervention.

Methods

This was a prospective interventional study of neonates with a central venous catheter (CVC) from a neonatal intensive care unit database, involving implementation of a multimodal approach to central venous catheter hub care using 2% chlorhexidine in 70% isopropyl alcohol and education of medical staff by audiovisual presentations. CRBSI rates in the pre-intervention period and postintervention period were compared.

Results

A total of 373 patients with a CVC (163 in the preintervention period and 210 in the postintervention period) were studied. Patient demographic and clinical characteristics were similar in the 2 periods. Extremely low birth weight infants constituted 40% of the cohort in the preintervention period and 38% of the cohort in the postintervention period. The CRBSI rate in patients with a umbilical artery catheter and an umbilical vein catheter decreased from 15/1000 catheter-days to 10/1000 catheter-days (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.17-0.91). The CRBSI rate in patients with a peripherally inserted central catheter decreased from 23/1000 catheter-days to 10/1000 catheter-days (OR, 0.33; 95% CI, 0.12-0.91). These decreased CRBSI rates were sustained despite high device utilization. The incidence of gram-negative septicemia also decreased. Ten CRBSIs were prevented by this multimodal approach, representing significant health care cost savings.

Conclusion

This study demonstrates significant decreases in CRBSI rate for all catheter types and birth weight categories associated with the multimodal intervention. Audiovisual education is an effective tool for practice change. Reeducation and compliance monitoring should be part of all nosocomial infection prevention strategies, resulting in significant savings in health care costs.

Section snippets

Setting and subjects

The site of this study was the neonatal intensive care unit (NICU) at Maria Fareri Children's Hospital, a 50-bed regional neonatal referral unit at Westchester Medical Center, New York Medical College. The study population included all patients admitted to the NICU between June 2005 and March 2007 with a CVC in place for more than 24 hours.

Study design and intervention

This was a prospective interventional study of CRBSIs. In June 2005, a database of all neonates with a CVC was maintained by the Division of Newborn Medicine

Results

A total of 373 out of 1188 admitted patients (31%) met the study criteria. This total included 163 patients in the preintervention period and 210 patients in the postintervention period, with 2926 and 3229 catheter-days, respectively. The catheters in use included 36 Broviac catheters, 76 PICCs, 60 UAC + UVCs, and 70 UVCs in the preintervention period and 41 Broviac catheters, 93 PICCs, 77 UAC + UVCs, and 97 UVCs in the postintervention period. The 2 groups were similar with respect to birth

Discussion

The present study has addressed the effects of changing practice and education on decreasing CRBSI rates. Compared with the NHSN's 50th percentile, the quarterly infection rate decreased to as low as 4/1000 catheter-days. The NHSN compiles rates from voluntary reporting hospitals, possibly resulting in the reporting of only optimal outcomes. Our multimodal intervention, including the audiovisual DVD presentation of the new CVC hub care protocol, was very successful in changing the practices in

Conclusion

This prospective interventional study has demonstrated a significant decrease in CRBSI rates for all catheter types and birth weight categories. The audiovisual educational intervention was an effective component of this multimodal infection control approach. We recommend including reeducation and compliance monitoring in all nosocomial sepsis prevention strategies; doing so can translate into significant health care cost savings.

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Conflicts of interest: None to report.

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