Major articleA multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection
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.