Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil

Background: Central venous catheter-associated bloodstream infections (CVC-BSI) are a frequent cause of morbidity and mortality in intensive care settings. Many strategies have been used to decrease the risk of CVC-BSI; however, few studies have explored the educational intervention as an approach to reduce the CVC-BSI rates. Objective: The purpose of this study was to determine the impact of an educational program targeted to specific points observed during CVC care practices on decreasing CVC-BSI in a medical intensive care unit. Methods: An educational program was developed by a multidisciplinary task force to highlight correct practices for CVC care. Relative risk ratios, 95% confidence intervals, and P values were determined for all primary and secondary outcomes. The X, linear test for trends of CVC-BSI rates was performed during the study period and the following year. Results: Forty-eight primary bloodstream infections occurred in 2450 catheter-days (20 per 1000 catheter-days) in the 16 months before the intervention. After the educational intervention and policy changes such as standardized povidone-iodine use during dressing care, the number of CVC-BSI dropped to 16 in 1381 catheter-days (11 per 1000 catheter-days), a decrease of 40%. The rate of CVC-BSI remained almost the same, 22 in 1701 catheter-days (12 per 1000 catheter-days), during the following year after the educational intervention (P = .07). The distribution of pathogens was different comparing the pre- and postintervention period. Staphylococcus aureus was the most common pathogen in preintervention, decreasing significantly during the study period (P = .02). The adhesion to the overall catheter care policy improved significantly in the postintervention period (P < .01). Conclusion: A multiple approach included an educational strategy targeted to specific problems observed during a careful evaluation of CVC care practices, and policy changes can decrease rates of CVC-BSI. However, despite the good results, our rates are still high, and reinforcement of CVC care practices will be continued.