A continuous quality-improvement program reduces nosocomial infection rates in the ICU

Objective: To assess the impact of a continuous quality-improvement program on nosocomial infection rates. Design and setting: Prospective single-center study in the medical-surgical ICU of a tertiary care center. Patients: We admitted 1764 patients during the 5-year study period (1995-2000); 55% were mechanically ventilated and 21% died. Mean SAPS II was 37+/-21 points and mean length of ICU stay was 9.7+/-16.1 days. Interventions: Implementation of an infection control program based on international recommendations. The program was updated regularly according to infection and colonization rates and reports in the literature. Measurements and results: Prospective surveillance showed the following rates per 1000 procedure days: ventilator-associated pneumonia (VAP) 8.7, urinary tract infection (UTI) 17.2, central venous catheter (CVC) colonization 6.1, and CVC-related bacteremia and 2.0; arterial catheter colonization did not occur. In the 5 years following implementation of the infection control program there was a significant decline in the rate per patient days of UTI, CVC colonization, and CVC-related bacteremia but not VAP. Between the first and second 2.5-year periods the time to infection increased significantly for UTI and CVC-related colonization. Conclusions: A continuous quality-improvement program based on surveillance of nosocomial infections in a nonselected medical-surgical ICU population was associated with sustained decreases in UTI and CVC-related infections.