An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center

Objective: To evaluate the effectiveness of an evidence-based intervention to prevent catheter-associated bloodstream infections among intensive care unit patients at a nonteaching, community hospital. Design: Nonrandomized pre/post observational trial. Setting: Two intensive care units at Missouri Baptist Medical Center, Saint Louis, MO. Participants: Nurses and critical care physicians. Intervention: A ten-page, self-study module on the prevention of catheter-associated bloodstream infections, lectures, and posters given between July and September 1999. Measurements: The incidence of nosocomial catheter-associated bloodstream infection and patient demographics were measured for patients admitted between March 1998 and July 2000. Main Results: Thirty cases of catheter-associated bloodstream infections during 6110 catheter-days were noted in the preintervention period (4.9 cases/1000 catheter-days) vs. 11 cases during the 5210 catheter-days in the postintervention period (2.1 cases/ 1000 catheter-days). The relative risk for catheter-associated infection in the postintervention period was 0.43 (95% confidence interval, 0.22-0.84). Among catheterized patients, Acute Physiology and Chronic Health Evaluation II score (25.2 preintervention vs. 25.1 postintervention; p = .86), hemodialysis (91 of 647 [14%] patients vs. 69 of 541 [13%]; p = .70), and the mean number of catheter days per patient (9.1 vs. 9.6 days; p = .46) did not differ between the pre- and postintervention periods. Conclusions: A focused, educational intervention among nurses and physicians in a nonteaching community hospital resulted in a significant, sustained reduction in the incidence of catheter-associated bloodstream infection.