A Multicenter intervention to prevent catheter-associated bloodstream infections

BACKGROUND. Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited. OBJECTIVE. To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections. DESIGN. An observational study with a planned intervention. SETTING. Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers. PATIENTS. Patients admitted during the study period. INTERVENTION. Updates of written policies, distribution of a 9-page self-study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence-based guidelines regarding central venous catheter ( CVC) insertion and care. MEASUREMENTS. Standard data collection tools and definitions were used to measure the process of care ( ie, the proportion of non-tunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter-associated bloodstream infection. RESULTS. Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% ( relative ratio, 0.73; 95% confidence interval [ CI], 0.61-0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% ( relative ratio, 1.29; 95% CI, 1.17-1.42), and the overall rate of catheter-associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter-days ( relative rate, 0.79; 95% CI, 0.67-0.93). The effect of the intervention varied among individual units. CONCLUSIONS. An education-based intervention that uses evidence-based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter-associated bloodstream infection rates.